BACKWARD   AND   FEEBLE-MINDED 
CHILDREN 


^ 

^::i 


WAR>X'ICK    &    YORK 
Baltimore 


(  .  '-w 


lEburalinual   }J5i|fhiilnui|  itlintnnraphg 

Backward  and  Feeble -Minded 
Children 


Clinical  Studies    in  the  Psychology  of    Defectives,  with  a  Syllabus 

for  the  Clinical  Examination  and  Testing 

of  Children 


BY 


EDMUND    BURKE    HUEY,  A.M.,  Ph.D. 

Lecturer  on  Mental  Development  in  The  Johns   Hopkins   University, 

Assistant  in  Psychiatry  in  the  Phipps  Clinic  of  the  Johns  Hopkins  Hospital 

Author  of  The  Psychology  and  Pedagogy  of  Reading 


^altiimur 
WARWICK  AND  YORK,   INC. 


Copyright,   1912 
Bv  WARWICK  AND  YORK, 


INC. 


TO 

Henry  Herbert  Goddard 

Trusted  and  generous  friend,  whose  own  devotion   to  research 

with  defectives  led  me  to  undertake 

these  studies 


PREI^\CE. 

Hic  public  schonls  receive  and  partiallx  cnnirdl,  for  a  time. 
almost  all  of  the  indivi'luals  wlm  will  later  trouiile  society 
as  delin(|iieut>  or  dependents,  or  who  will  be  troubled  them- 
selves b\-  insanity  or  other  forms  of  mental  disturbance. 
Usualh'  onl\-  the  lowest  ^'rade  of  feeble-minded  children  fail 
to  find  their  way  to  school. 

Excejjt  in  the  case  of  infre(|uent  otfenders.  and  e.\cei)tin^' 
also  perscMis  whose  UK'ntal  disturbance  is  due  to  sjjecitic  kind'~ 
of  poisoning",  these  individuals  usualh'  show  excei)tional  con- 
duct even  in  their  school  jjcriod.  and  the_\-  would  be  taken  ac- 
count of  as  children  who  need  s])ecial  attention,  1)\'  anxone 
trained  to  and  ex])erienced  in  clinical  obser\alion.  There  is 
here  the  possibilit}'  of  studying"  ///  (.idrancc  the  main  sources 
of  social  danj^er  and  of  indivi<lual  mistit  and  shipwreck. 
There  is  equalh'  the  ])ossilMlitv  of  forestalling'  man\-  of  these 
ills  and  of  takini^'  awa\'  in  advance  the  stin^'  and  smart  from 
many  an  unhaj)])}"  life.  Aside  from  the  service  to  be  rendered 
to  normal  children  </;/(/  teachers  b\-  wise  clinical  oversio-ht  and 
counsel,  the  recording-  of  exce])tional  functioning-s  and  facts 
in  the  case  of  these  exceptioual  childien.  the  canvassing-  of 
their  potentialities,  favorable  and  unfavorable,  would  be  of 
inestimable  service  for  the  intelligent  stud\'  of  society's  ills 
and  for  the  solution  of  the  problems  that  these  individuals 
then]selves  present. 

( )f  most  immediate  need  is  the  proxdsion  of  si)ecial  classes 
for  children  who  need  a  s])ecial  pace  or  course  or  treatment 
to  enal)le  them  to  win  success  at  something  useful  instead  of 
failure  at  something  useless.     With  this  comes  the  planning 


X  PREFACE. 

and  installing  of  manual  and  occupational  courses  by  which 
the  most  can  be  made  of  even  slender  resources.  These 
classes  and  courses  will  at  once  relieve  teachers  from  the 
worrv  of  impossible  discipline  and  from  the  dragging  along 
of  the  retarded. 

Let  us  not  delude  ourselves  with  the  hope  that  the  de- 
fectives are  to  be  cared  for  in  institutions.  Existing  institu- 
tions cannot  house  one-tenth  of  the  number.  ]\Iore  institu- 
tions should  be  built,  but  even  then  the  most  troublesome  and 
dangerous  higher-grade  children  will  only  exceptionally 
reach  them.  The  cities  must  plan  to  manage  these  in  situ; 
must  plan  to  exercise,  through  the  schools  especially,  a  per- 
manent directive  and  educative  control  that  will  make  self- 
supporting  and  contented,  if  humble,  citizens  of  thousands 
who,  without  such  oversight,  become  the  unproductive,  un- 
happy dregs  of  perversion.  A  competent  clinician-educator 
in  the  schools  can  render  at  least  the  service  of  an  institution 
superintendent  in  organizing  the  activities  of  defectives ;  and 
far  more,  for  he  can  really  save  the  state  the  cost  of  main- 
taining an  additional  institution  for  such  cases.  Of  course, 
the  em])loyment  of  one  or  another  of  the  means  proposed  for 
preventing  procreation  by  defectives  is  presupposed  for  such 
treatment  /'//  sii\t. 

Of  even  greater  importance,  we  may  find,  will  be  the  early 
diagnosis  of  dangerous  mental  tendencies  and  habits,  that 
occur  even  in  the  brightest  and  best  of  school  children.  The 
easing  of  adaptations  in  critical  directions  and  periods,  judi- 
cious counsel  to  parents  and  others  who  mav  direct  the  child 
toward  such  levels  of  occupation  and  environment  as  will  be 
safest  and  most  productive  for  him — these  are  services  which 
the  history  of  cases  of  insanitv  teach  us  may  be  rendered  to 
thousands  of  threatened  lives.  The  schools  and  institutions 
are  already  beginning  to  look  for  men  competent  to  do  this 
work,  and  psycliology  and  medicine  are  just  beginning  to 


PKKl  ACi:.  XI 

realize  that  they  imist  jniii  hands  witli  eacli  ntlier  and  with 
sociolo|n;'v  and  e<hicatii)n  in  training"  clinicians  ca])ai)le  of 
rendering-  this  service. 

This  little  \()lnme  suj^'t^ests  hnt  a  few  of  the  ])i)ssil)ilities 
of  such  clinical  work.  The  studies  are  of  >chool  children  or 
of  persons  who  have  heen  school  children.  With  normal 
home  conditions  few,  if  an\'  of  them,  would  have  reached  an 
institution.  The\'  are  just  such  e.\ce])tional  children  as  one 
meets  in  the  schools  of  a  humlred  cities,  and  they  are  of  con- 
siderablv  hi^^her  i^rade  than  very  man\  that  one  finds  there. 
If  they  could  have  been  studied  in  iheir  home  schools,  I 
should  know  a  good  deal  more  about  them.  I'.ut  the  ])ictures 
of  them  here  are  as  full  and  as  true  as  circumstances  per- 
mitted me  to  make  them. 

Years  ago  at  Heidelberg,  Professor  Kraepelin  told  me,  with 
enthusiasm  which  T  well  remember,  how  much  he  thought 
might  come  from  an  intensive  clinical  stud\-  of  a  group  of 
some  thirt\-  school  children.  ( )n  my  way  to  Lincoln  Dr. 
Adolf  ]\[eyer  encouraged  me  to  undertake  some  such 
study  in  the  Illinois  institution.  The  results  of  a  ])ractice 
try-out  of  the  plan  are  here  Ijefore  the  reader.  There  are 
always  limitations,  methods  were  to  be  made,  and  of  course 
the  studies  are  imperfect  enough.  lUit  whether  for  my  de- 
velopment as  a  psychologist  and  educator  or  for  the  render- 
ing of  my  most  useful  service,  I  could  hardly  ask  a  better 
opportunity  than  to  repeat  such  a  study  in  a  ])ublic  or  ]irivate 
school,  particularly  if  the  stud\-  could  be  made  under  the 
auspices  of  a  well-equi|)pe(l  imiversity. 

To  Superintendent  If.  (i.  Ilardt.  who  had  the  foresight  to 
found  and  su])])ort  the  department,  and  to  the  Illinois  State 
Board  of  .Vdministration.  whose  attitude  has  been  one  of 
most  cordial  and  intelligent  co-0]K'ration,  my  best  thanks  are 
due.     I  wish  to  acknowledge,  as  well,  the  effective  assistance 


XU  PREFACE. 

of  physicians,  teachers,  and   attendants,  and   especiahy  the 
uniform  courtesy  and  interest  of  the  children  themselves. 

Dr.  Goddard  has  been  larqel}'  responsible  for  my  under- 
taking- and  continuing  the  work,  and  has  aided  me  at  every 
point.  Miss  Julia  A.  Lathrop,  of  Hull  House,  and  Dr. 
William  Heal}-,  of  the  Juvenile  Psychopathic  Institute,  have 
given  encouragement  and  assistance.  Finally,  the  co-opera- 
tion of  my  publisher  has  been  most  effective  and  cordial,  and 
has  permitted  the  book  to  develop  well  beyond  the  original 
plan.  I  regret  only  that  other  undertakings  have  prevented 
my  attending  to  certain  details  of  literary  expression  which 
may  have  needed  modihcation  in  this  change  of  plan. 

E.  B.  H. 

Baltimore, 

Chrislmas.   1911. 


CONTENTS 

CllAl'TLlR  1. 

PACE 

iNTKonrc'iiox    I 

ClIAl'Tl-.K  II. 

Cl.ASSIFICATIOX  AXn  Tl'-.K  M  I  NOI .( l(  ;\ 5 

cii.\rri{R  J 1 1. 

Ci.i-\'i(.AL  Studiks  v\-  r>nKi)i:K  L"\si;s 22 

CHAPTER  I\-. 

LLIXICAI,  SlUDlKS  OF    lioKDKK   CaS1:S lO/ 

CHAPTER  W 
T  \!iri.Ai'i()xs  oi"  Data,  Sl'(;(;i-:sti-:i)  (ikoi'ps.  Lixes  of 
Transition    from    ]^'i:fi'.ff-Mixi)i:i)Xi-:ss   to   Xox- 
Eeeble-Mindednfss 157 

CHAPTER  \  I. 

A  Svi-LAUl'S  1-OR    I'llI-:  Cl-IXK'Al,   I^X AM  IXA  rioX  OF  ClIIL- 

DKHX 173 

.  CHAPTER  \1T. 
Coxcu'siox — The  AIi:xial  P'rxcrioxs  to  he  Testf.o 

Axi)  (  )i!Si:r\  El) 203 

Bibliography    209 

Index  of  Cases 217 

IXDEX  OF  Sl'P.JECTS  AXI)  X  A  M  i:S 219 


BACKWARD   AND   FEEBLE-MINDED 
CHILDREN 


u 


0 


BACKWARD   AND   FEEBLE-MINDED 
CHILDREN. 

ClIAP'lER  1. 

Txi'konrcTiDx. 

(  )t  t!ic  ])(i]nilatii)n  of  I'jiL^land  and  Wales,  il  !ia>  l)ocn 
found  that  i  in  24<S  are  feeljle-niinded,  and  tlial  almost  as 
many,  i  in  ij}^,  are  insane,  it  is  i)rohable  that  we  have 
quite  as  many  feeble-minded  in  America.  For  the  most  part 
they  are  livi!!,^'  in  the  families  to  which  they  !)el'in>:.  Many 
of  the  states  have  not  provided  institutions  for  their  care. 
In  none  is  there  ])rovision  for  more  than  a  minor  i)ercontage 
of  the  total  number,  even  if  the  institutions  both  ])ublic  and 
]M-ivate  were  filled  to  their  ca])aeity,  and  they  usually  are  so 
filled.  13r.  ( ioddard  (juotes  Dr.  l-^rnald  as  sayirii;-  that  "There 
are  at  least  200,000  ])ronounced!y  feeble-minded  ])ersous  in 
the  United  States.  ( )f  these  16,000  are  inmates  of  alms- 
houses, while  only  18,000  are  cared  lor  in  special  institu- 
tions." 

The  greater  number  of  this  vast  army  of  defective'^  are 
for  a  part  of  their  lives  pupils  in  the  jjublic  scIkjoIs.  Xearlv 
43  per  cent,  of  a  year's  c()nsecutive  admissions  to  the  Illinois 
state  institution  had  spent  at  least  a  year  in  the  pul)lic  schools. 
T)Ut  of  the  far  larger  numliers  who  did  not  come  to  the  in- 
stitution, it  is  certain  that  the  great  majoritv  are  higher- 
grade  children  who  would  l)e  still  more  likel\-  than  the  others 
to  spend  some  years  in  school. 

The  problem  of  the  feeble-minded  is  thus,  at  least  at  i)res- 
ent,  a  problem  of  the  homes  and  of  the  jniblic  schools  rather 
than  one  of  institutions.    Indeed,  it  will  lojio-  remain  so.     Xot 


2  BACKWARD    AND    F l-:i:i!r.l£-.M  INDED   CIIII.DREX. 

only  do  parents  love  to  cherish  these  maimed  members  of 
their  Rock,  but  the  higher-grade  children  usually  find  means 
of  avoidinof  detention  in  institutions,  and  spend  their  years  in 
their  home  localities  or  in  wandering  at  large.  Even  so,  they 
are  born  to  trouble  and  vexation  of  themselves  and  others. 
Their  presence  and  conduct  subject  their  families  to  humilia- 
tion ;  they  are  an  intolerable  burden  to  the  teacher  and  to  the 
schools ;  they  recruit  the  ranks  of  criminals,  ])rostitutes. 
vagrants,  almstakers,  and  insane.  Indeed,  society  is  coming 
to  realize  that  all  these  latter  conditions  for  the  most  part 
proceed  from  the  same  source  in  weakened  or  tainted  hmuan 
stock :  and  that  the  elimination  of  these  classes  is  a  matter 
of  the  elimination  of  the  causes  o])erative  in  the  degeneration 
and  reproduction  of  weak  and  tainted  human  stock.  This 
prol)lem  of  prevention  and  elimination  is  the  more  funda- 
mental one,  and  there  are  already  known  means  to  its  partial 
solution  which  will  become  effective  just  as  fast  as  society 
becomes  better  organized  and  more  enlightened. 

The  presently  pressing  problem  is  one  of  the  social  adap- 
tation, of  this  army  of  unfortunates,  to  an  environment  and  to 
a  level  of  mental  functioning  which  will  make  the  most  of 
their  scanty  resources  while  assuring  the  protection  of  society 
itself.  To  help  in  solving  both  these  problems  the  scientific 
studv  of  the  feeble-minded  is  recentl\-  being  taken  up  with 
enthusiasm,  both  in  Europe  and  in  America. 

The  case  material  for  such  study,  while  present  in  many 
homes  of  ever}-  neighborhood,  is  more  accessible  in  the  im- 
graded  or  special  classes  that  are  more  and  more  being  or- 
ganized in  the  public  schools  of  cities  and  towns.  The 
Parental  and  Reform  Schools  have  many  such  children,  and 
the  schools  for  wayward  girls  as  well.  The  Juvenile  Court 
has  to  do  with  many  of  them,  and  they  are  to  be  found  in 
jails,  penitentiaries,  almshouses,  and  hospitals  for  the  insane. 

On  the  whole,  the  institutions  specially  provided  for  the 


i.\  rkdinc  iio.v.  3 

fccble-niindfil  oiTcr  the  greatest  a(lvantai;c<  for  such  sludy. 
J-"roiii  the  cmins  and  schnols  and  ahTishousc^  and  families 
the  children  of  all  ty])es  are  sent  on  to  iIk-sc  institutions, 
which  l)econH'  veritahU'  nuisenins  of  detect  of  every  type,  to 
he  studied  liere  at  the  student's  will.  There  is  the  single  se- 
rious disadvanta.^e  that  the  child  is  here  separated  from  h\< 
native  ha!)itat,  and  thu>  the  family  and  jjersonal  history  is 
(»ften  hard  to  obtain,  and  cannot  h.e  ol)served  in  its  i)resent 
elTect  u])on  the  child.  <  )n  the  other  haml.  the  child  here  lives 
in  an  environment  which  can  lie  matle  and  varied  to  order, 
and  the  efifect  of  various  en\ironmental  and  social  factors  can 
lie  studieil  with  almost  lahoratorx-  precision.  This  latter  is  an 
o])portunity  for  ex])erimental  i)eda,H()i;'v  which  will  doubtless 
be  taken  advanta.ye  of  In-  de])arlnients  i>f  edueatiiin  in  state 
universities,  wdiich  ma\-  affiliate  with  ])sycholo!^\-  deiiartment-^ 
in  the  institution^. 

The  establishment  of  I  )r.  (loddard's  lahorator\-  in  the  .\'e\v 
Jersey  Trainiui;-  School  at  X'ineland  marked  the  bcLiinniuL;' 
of  a  new  era  in  the  American  study  of  the  feelile-nn'ndeck 
Following  the  lead  of  the  New  jersev  school,  the  Illinois 
state  institution  I'or  the  feeble-minded,  entitled  the  Lincoln 
State  School  and  C'olonw  was  the  first  of  the  state  institu- 
tions to  establish  a  psycholo,'.;ical  department.  The  ])resein 
V(jlume  presents  some  of  the  main  results  of  the  writer's  work- 
in  charge  of  this  department  for  a  year  and  a  half  from  its 
inception. 

There  were  few  traditions  and  no  rules  a-  to  what  such 
a  department  should  do  or  what  studies  >hould  be  under- 
taken. As  the  work  was  actually  done  anil  as  it  is  here  re- 
ported it  consisted,  first,  in  a  provisional  classification  and 
description  of  the  membership  of  the  institution  as  a  whole 
beginning  with  the  new  admissions,  involving  the  adoption 
of  certain  routine  tests  and  of  an  ofHcial  terminologv  in  terms 
of  which  classification  could  be  made:    Secontl.  the  clinical 


4  IJACKWAKD    AND    FEECr.E-.MINDED   CIIH^DREN. 

study  of  thirt}-t\vo  iDorder  cases  of  backwardness  and  feeble- 
mindedness, made  upon  the  liighest-grade  children  of  the  in- 
stitution :   Third,  a  formulation  of  the  methods  of  case  studv. 


A  CORNER   OF  THE   I.INCOT.N   T>ABORATORY. 

and  of  suitable  research  tests  for  the  mental  functions  in- 
volved in  mental  defect.  Without  further  preliminaries,  the 
work  will  be  presented  in  this  order. 


CIIAPTKR  |[. 
CLASSIFICATK  )X  AND  TERMIX'OLOGY. 

A  preliminary  problem  had  to  he  settled  early,  that  of  a 
classitication  system  and  a  fixation  of  usage  for  the  most 
common  terms.  The  words  idiot,  inihccilc.  and  feeble-minded 
have  been  used  in  the  most  varied  and  contradictory  senses. 
even  in  the  courts  and  in  the  institutidus  themselves,  to  sa\ 
nothing-  of  the  confusion  of  laymen.  It  had  become  abs(»- 
lutely  necessary  to  come  to  some  agreement  about  them. 
Then  there  are  many  forms  of  each  of  these:  man\-  causes 
have  operated  and  many  types  have  been  produced.  And  as 
to  the  intelligence,  there  are,  of  course,  many  degrees  to  be 
distinguished. 

The  possible  groupings  of  the  feeble-minded  are  thus 
most  various,  such  as  into  Alongolian,  cretin.  e])ileptic,  etc. : 
into  excitable  and  apathetic,  congenital  and  acciuired,  trau- 
matic, tuberculous,  ad  iiifiitititiii.  All  these  are  legitimate 
groupings,  and  account  should  of  course  be  taken  of  every 
child  in  terms  of  them,  as  far  as  they  apply.  Hut  for  actual 
handling-  of  the  cases,  for  fitting-  them  to  work  in  school  and 
in  occuj^ations,  a  description  and  classification  in  terms  of 
mental  capacity  and  character  seemed  certainl\-  to  be  what 
was  needed. 

To  make  a  satisfactory  mental  descrijjtion  is  one  of  the 
most  difficult  of  tasks ;  and  until  very  recently,  if  not  even 
now,  the  psychologists  have  been  less  able  here  than  the 
novelists  and  draniatists.     To  measure  mental  capacity,  on 


6  BACKWARD    AND   FEEIU^E-M  IXDED   CHILDREN. 

the  otlier  hand,  has  iisnalh-  hcen  thought  to  be  altogether  im- 
possible. I'>ut  a  beginning  had  to  be  made.  Happily,  it  was 
found  that  the  Knglish  and  iM-eneh  writers  were  tending  to 
a  more  or  le.ss  eommon  ]M-aetice  in  the  main  lines  of  classi- 
fieation  and  in  the  use  of  terms.  Jn  1004  the  English  Royal 
Commission  reeommended  that  the  term  fccblc-iiiiiulrd 
should  include  all  mentally  defective  children  who  needed 
institution  care,  in  three  ascending  grades  ofidiot,  imbecile, 
and  fcchlc-mjiuicd  proper,  b'or  the  Fren€4iT-?rofessor  Binet, 
their  most  nVfluential  adviser  in  these  matters,  makes  three 
grades  similarlv.  lie  delimits  them  more  definitely  in  terms 
of  the  amount  of  intellectual  retardation  as  measured  by  a 
scale  of  tests  of  the  intelligence. 

At  Mneland  and  at  Lincoln  the  Ijinet  classification  and 
tests  were  found  usable  and  useful.  The  children  were  l)e- 
fore  us:  and  as  no  other  system  offered  iialf  so  practicai^le  a 
means  of  bringing  order  into  chaos,  we  proceeded  to  classify 
in  these  terms  and  to  use  these  tests  for  routine  examinations. 
In  May,  1910,  the  Amc'rican  Association  f(jr  the  Study  of  the 
Feeble-Minded  met  at  Lincoln.  After  examining  the  work 
of  these  two  institutions,  they  took  ofiicial  action  settling" 
at  least  tentatively,  for  .American  practice,  the  following 
points,  ])ractically  an  endorsement  of  wdiat  they  found  in 
successful  operation  in  these  institutions:  i.  The  term 
"feeble-minded"  is  to  Ijc  used  generically  to  include  all  de- 
grees of  mental  defect  due  to  arrested  or  imperfect  mental 
development,  as  result  of  which  the  ])erson  so  afifected  is 
incapable  of  competing  on  equal  terms  with  his  normal  fel- 
lows, or  of  managing  himself  or  his  afi'airs  with  ordinary 
prudence.  2.  The  feeble-minded  are  divided  into  three 
classes,  viz. : 

Idiots. — Those  so  defective  that  the  mental  development 
never  exceeds  that  of  a  normal  child  of  about  two  years. 

Imbeciles. — Those  whose  develoi)ment  is  higher  than  that 


CLASSIKJCA'i  I(J.\     AM)    ll-.K  M  1  .\(  )1.()(  ;N'.  7 

of  an  idiot,  Init  whose  intelligence  does  not  exceed  thai  of  a 
normal  child  of  ahont. seven  years. 

Morons.—  Those  whose  mental  development  i>  ahove  that 
of  an  imbecile,  but  does  not  exceed  that  of  a  normal  child  of 
about  twelve  years. 

They  fm-ther  ajji^rove  of  the  n>e  of  the  older  ])atholo-ical 
terms,  such  as  hydroce])halic,  microce])halic.  ])aralytic.  etc. 

Each  of  the  three  grand  divisions  is  sulidi\'ided  into  lou', 
iiiuldic,  and  ///.i,'//.  The  use  (jf  the  terms  is  illustrated  in  such 
combinations  as  "low  Mongolian  imi)ecile,"'  "high  epileptic 
moron."  Moron,  a  new  term.  dis])laces  the  use  of  fccble- 
niiiulcd  in  the  restricted  sense,  for  the  highest  grade  of  the 
feeble-minded. 

Ihnet  irses  the  terms  icfiot,  iinl>Ci-ili\  and  dchilc  i  nearh'  cor- 
res])on(hng  to  moron),  with  no  stigma,  and  not  to  name 
grades  of  defect  so  nmch  as  degrees  of  intelligence,  which 
ma}^  change  with  age.  an.  imbecile  i)er]iaps  becoming  a  moron. 
He  wotdd  not  place  children  in  the  si)ecial  school  classes  for 
defectives,  on  account  fif  mental  retardation  alone,  unless 
this  retardation  amounts  to  three  years  or  more,  or  to  at 
least  fivo  years  if  the  child  is  under  nine.  Presumablv  he 
would  not  ap])l_\-  the  terins  idiot,  imbecile,  etc..  for  rcfarda- 
fioii  alone,  unless  it  amounts  to  as  much  as  this,  and  not 
necessarily  even  then.  I 'or  the  still  slighter  degrees  of  re- 
tardation he  would  use  the  terms  Hack'cCiinl  for  the  mereh' 
retarded  and  l.histab/c  for  the  ec|ually  large  number  whose 
instability  is  their  most  prominent  characteristic.  We  mav 
convenienth-  ((ualify  these  terms  b_\  ,-m\-  others  that  w  ill  fur- 
ther define  the  condition,  in  such  combinations  as  "morally 
imstable,"  "neurasthenically  unstable."  etc. 

In  spite  of  Binet's  suggestion  ami  ])ractice,  the  terms 
idiot,  imbecile,  moron,  and  feeble-minded  will  continue  to  be 
thought  of  as  terms  of  final  diagnosis,  and  it  is  probabl)'  Ijest 
not  to  use  them  when  the  child  gives  promise  of  tleveloping 


8  liACKWAKD    AM)   FKKULl^- M  I  NDED   CHILDREN. 

much  beyond  the  Hmits  of  mental  age  imphed  by  the  term  in 
question.  This  practice  is  especially  advisable  if  the  child 
is  quite  voung.  In  these  latter  cases  he  should  simply  be 
recorded  as  mentally  "Retarded"'  in  the  degree  found,  with 
such  other  terms  as  best  describe  his  actual  condition. 

It  will  be  found  that  the  term  fccblc-uiiiidcd  cannot  always 
be  applied  to  children,  especially  to  children  under  fifteen, 
from  the  mere  fact  of  their  showing  any  given  amount  of  in- 
tellectual retardation  as  measured  by  any  scale  of  tests. 
Usually,  it  is  true,  when  the  child  shows  more  than  three 
years  of  retardation  it  is  feeble-minded.  But  there  arc 
cases  in  which  the  intelligence  is  inhibited  even  to  this  extent, 
in  functioning-  or  in  development,  from  causes  wdiose  re- 
moval permits  the  child  to  prove  that  he  was  never  of  the 
feeble-minded  kind.  On  the  other  hand,  I  shall  later  present 
notes  of  manv  cases  showing  less  than  three  years  of  retarda- 
tion, but  which  are  undoubtedly,  and  some  of  them  very  fun- 
damentally, feeble-minded.  /\s  a  matter  of  fact,  all  psy- 
chiatrists know  that  feeble-mindedness,  like  insanity,  involves 
much  more  than  the  intelligence;  and  its  correct  diagnosis 
often  involves  the  expert  consideration  of  various  clinical 
phases,  and  cannot  be  made  by  the  automatic  application  of 
any  schema  or  scale.  It  is  evident,  however,  that  diagnosis 
may  be  greatly  facilitated  and  in  the  majority  of  cases  may 
be  practically  accomplished  by  a  careful  measurement  of  the 
intelligence. 

The  upper  limit  of  feeble-mindedness  was  placed  at  twelve 
years  of  mental  age  because  observation  and  test,  agreeing 
completely  at  \'ineland  and  at  Lincoln,  showed  that  children 
of  any  higher  intellig;ence  are  able  to  "float"  in  society,  and 
insist  on  doing  so.  They  manage  to  keep  out  of  the  institu- 
tions or  to  get  out  when  placed  in  them.  In  France  the  de- 
fectives "float"  at  a  still  lower  level:  and  indeed  it  will  be 


(.  I.ASSIIU  AlloX     AMJ    TKKMIXol.OCN'.  9 

seen  that  the  levels  of  eleven  and  twelve  }ears  of  mental  aii'e 
have  few  representatives  in  the  Illinois  institution. 

It  nnist  not  he  snpjjo^ed  that  ahove  the  twelve-year  level 
we  shall  at  once  find  the  levels  of  normality.  We  hci^iii  to 
find  them  here,  if  not  even  a  little  lower,  in  those  small  in- 
telligences which  (|uite  snfhce  to  happily  till  some  sim])le 
s])here  in  which  they  ma}-  have  had  their  evolution,  h'rom 
this  upward  the  successively  higher  levels  of  normalit}-  itself 
are  as  manifold  as  are  the  degree>  of  difficulty  to  he  met  by 
individuals  in  a  complex  civilization.  Xormality  of  intelli- 
gence is  not  a  fixed  strength  of  intellect  to  he  required  of  an 
entire  population.  The  various  industrial  and  professional 
classes  come  to  have  intelligences  that  center  ahout  nnrmals 
of  different  heights.  The  tests  for  twelve  years  of  mental 
age  pass  the  candidate  to  service  in  the  least  exacting  strata 
<jf  society. 

But  the  transition  from  feehle-mindednos  i>  not  merelv  to 
the  lower  levels  of  normality.  The  cases  to  he  presented  will 
best  illustrate  how  feeble-mindedness  blends,  along  most  of 
its  upper  margin,  into  the  ])0])ulous  and  turbulent  zone  of 
the  psycho-neuroses. 

To  return  now  to  our  system  of  cla>sihcati<in  :  The  use  of 
the  Binet  tests,  while  thought  of  in  the  adoption  of  the  s_\>- 
tem,  is  by  no  means  a  necessity.  1  he  Binet  >cale  gives  the 
correct  "idea"  of  a  scale  that  Is  implied,  viz..  a  s}stematicall\- 
arranged  table  of  norms  for  a  variet\-  of  mental  ])erformances 
normal  to  each  age  of  childhood.  W'c  shall  extend,  ex])and. 
or  even  displace  the  Binet  scale  just  as  fast  as  we  determine 
more  of  these  successively  develo])ing  cai)acities.  Ilinet  ha^ 
as  least  proved  the  possibility  of  measuring  the  advance  in 
mental  efficiency  that  normally  comes  with   increasing  age. 

The  Binet  scale,  a  condensed  and  revised  stateiuent  of 
which  is  given  in  a  later  chapter,  i>  a  scries  of  some  64  tests 
graduated  in  order  of  increasing  difiiculty  and  grou]ied  in 


lO  I'.At  KWAIU)    AND   FI£Kl!Lli-M  I  .\UI-:D   CHILDREN. 

sets  of  five  tests  each,  which  can  just  he  passed  by  the  aver- 
ao;e  normal  child  of  the  given  age.  The  tests  thus  give  a 
scale  (jf  norms  for  the  ages  one  year  to  twelve  years  inclu- 
sive, originall}'  one  to  thirteen  inclusive.  The  revised  scale 
])rovi(les  further  tests  for  fifteen  years,  and  for  the  "adult" 
intelligence  of  "above  fifteen  }ears."  In  being  tested,  the 
child  begins  with  tests  that  he  can  easily  do,  and  tries  pro- 
gressively more  dit^cult  ones  until  he  can  do  no  more.  His 
mental  age  is  then  computed  from  the  height  reached  in  the 
scale  combined  with  the  total  number  of  tests  passed. 

There  are  three  luain  results  obtained  bv  the  use  of  the 
scale:  i.  The  child's  intellectual  level  is  measured.  2.  Cer- 
tain important  practical  data  are  obtained,  concerning  the 
child's  ability  to  read,  write,  draw,  use  language,  use  num- 
bers, use  money,  do  errands,  imitate,  etc.  The  original 
scale  as  used  in  our  Lincoln  tests  gave  more  of  this  in- 
formation than  does  the  revised  scale,  including,  as  it  did. 
tests  for  reading,  writing,  the  memory  for  what  is  read,  etc. 
3.  The  tests  o])en  u]>  the  case  for  varied  ol)servation,  giving 
the  exanfiner  o])portunity  to  make  supplementary  notes  of 
the  child's  attitude,  his  emotional  condition,  his  speech  and 
movements,  and  various  other  characteristics  of  his  responses 
and  conduct.  These  notes  all  help,  along  with  the  count 
proper,  to  give  a  total  picture  and  estimate  of  the  child's  men- 
tal character  and  capacity. 

Applying  these  methods  and  means  of  classification  for  .i 
year  and  a  half  in  the  Illinois  institution,  I  have  selected  the 
consecutive  admissions  of  one  ])eriod  of  twelve  months  as 
being  approximatel}'  representative  of  what  the  institution 
would  show  for  its  present  more  tlian  1300  inmates.  Of 
course,  the  death  rate  and  the  frecjuency  of  discharge  and 
l)arule  are  greater  for  some  classes  and  degrees  of  defect 
than  for  others.  As  a  consequence,  the  percentages  found 
for  new  admissions  difi'er  somewhat  from  those  of  a  census  of 


CI.ASSII-ICAIION    AM)   TICK  M  I  .\(  )l.(); '.N' 


II 


NEW  ADMISSIONS  FOR  ONE  YEAR,ig09-10 


1^3      CASES. 


SPEfCH    30 
DEFECT 


C0NVUL-J5 
No.  OF  SIGNS 

Cases 


EP  J2 


MENIN7?  I 

GITlsa  ■ 

MON-  6        ■  ■ 

60LS|       I  I 


VIS.DEFECT 


6i SCHOOL 


"I^^Zl^.b    217    V/3    629    100     ^^  r  2  ?     5g2    9.1      " 


^yyoAUD.D. 
CRETIN 


I-'ii;.    2. 


12 


1!.\C  IkW  AKU    AM)   Fl':i-:iiLi:-Mi.\L)i:U   CHILDREN. 


population,  but  in  certain  respects  arc  of  even  greater  value 
than  the  latter. 

The  new  admissions  from  November  17,  1909,  to  Novem- 
Ijer  16,  1910,  numbered  147.  Fig'.  2  presents  some  of  the 
more  important  general  data  concerning  the  143  cases  for 
Avhom  the  data  could  be  obtained.  Fig.  5  tabulates  the  re- 
sults of  the  mental  examinations  for  140  of  these  cases,  seven 
having  failed  of  examination  by  early  discharge,  parole,  or 
death. 

Reviewing  the  data  presented  in  Fig.  2,  it  is  noticeable 
that  the  Mongolians,  4.2  per  cent.,  and  the  cretins,  two-thirds 
of  I  per  cent.,  though  they  are  types  which  are  much  dis- 
cussed and  which  are  of  much 
interest  to  science,  are  of  com- 
parativ(;ly  rare  occurrence.  Dur- 
ing the  year  the  institution  has 
reported  but  four  cretins  from  the 
entire  population,  and  one  of 
these  has  recently  died. 

Thus  far  the  ^^fongolians  have 
tested  prctl}'  uniformly  to  a  men- 
tal age  of  four  or  five  years,  both 
at  Lincoln  and  at  \'ineland.  Of 
course,  many  exceptions  to  this 
will  doubtless  be  found.  The 
.Mongolians  are  steady,  docile, 
and  tractable,  and  are  probably 
more  numerous  than  is  indicated 
by  institution  records,  since  they 
can  be  easily  managed  at  home. 
They  have  a  pretty  high  mortal- 
itv  as  well,  due  to  the  generally  "unfinished"  condition  of 
their  organs  and  tissues. 

Twelve  and  a  halt  per  cent,  or  one-eighth  of  all  new  ad- 


FiU'.  o.— Typical  frctin  In 
infancy.  (4rcat  progress 
since  under  treatment 
witli  tliyroid  extract. 


CI.ASSJl- U  A  ri().\    AND    lllk  M  ]  XOI .()(  :n\ 


13 


missions,  were  stated  in  haw  had  ineninL;iti>  or  '"liraiii  fever." 
They  form  a  ^rou])  (if  ca-~L'>  which  u-^uall\-  ^liuw  >\-m|)to]n-- 
])eeuliar  In  lhi>  ca^l^atinll.  and  the\-  make  hltk'  iin])rnvemenl. 
They  merit  a  larj^er  share  n\  attention  and  >tnd\  tlian  thev 
iiave  nsnally  receiveil.  a-^  enm])ared.  for  c.\am])le.  with  the 
less  numernns  MnnL>()han>  and  cretins. 


FiK-    4.— KxliaustPrt    by    convulsions.      Mentnl    (Icvcldpiiii'iit    :ir- 
restod  at  2%  years  by  iiicninuii  is. 

Forty-one  and  three-tenths  ])er  cent  are  reported  to  have 
had  convulsions  at  one  time  or  another,  thouoh  but  21.7  per 
cent  certainly  are  or  have  been  epileptic.  It  is  to  be  noted, 
as  well,  that  epileptics  are  not  "supposed"  to  be  admitted  to 


14  I'.ACKWAKD    AND   FERULE- M  I  XDED   CIIIf.DREX. 

this  institution.  ITowever,  they  are  not  provided  for  else- 
wiiere  in  the  state. 

Of  tlie  chiUhx'n  wliose  intelligence  made  it  possible  to 
measure  the  visual  and  auditory  acuit}',  58.2  per  cent  show 
not  more  than  two-thirds  vision  in  one  or  both  eyes.  IJesides. 
there  were  many  other  cases  of  straljismus  and  of  other 
visual  defects.  Xine  and  one-tenth  per  cent  show  auditorv 
defect  tiTave  enoui^h  to  l)e  noticeable  in  the  whis]iering"  and 
conversation  tests  for  "]iractical"  normalitv.  A  large  per- 
centage of  the  children  tested  have  uv  have  had  disease  of 
the  (,"-ars. 

The  comparative  constanc}-  \\\t\\  which  sjieech  defect  ac- 
companies mental  defect  is  shown  by  the  fact  that  nearly 
63  per  cent  of  all  new  admissions  have  persisting  defects  of 
articulation,  not  ciiunting  thc^se  who  have  merely  defective 
grammatical  usages  or  tendencies  to  confusion  in  speech. 

The  fact  that  42.7  ]ier  cent,  indeed  the  majority  of  all 
l)ut  the  lowest  idiots,  had  spent  at  least  one  vear  in  the 
schools,  gives  food  for  ])edagogic  reflection.  .Some  of  these 
children  had  spent  from  five  to  eight  years  in  the  first  or 
first  and  second  grades. 

ddie  mental  examinations  whose  results  are  tabulated  in 
Fig.  5  show  that  of  the  }ear's  new  admissions  thirty-three 
were  idiots,  fifty-nine  were  imlieciles.  and  forty-eight  were 
morons,  using  these  terms  in  the  Ihnet  sense  as  indicating 
merely  the  intelligence  level  actually  attained.  The  females 
numbered  but  si.xty-one  to  the  males  seventv-nine.  and  were 
not  more  numerous  than  the  males  at  any  mental  age.  Men- 
tal defect  is  generally  found  to  be  more  frequent  among" 
males.  It  will  be  noted  that  there  are  more  cases  at  a  mental 
age  of  two  years  than  at  any  other.  Probably  this  is  because 
these  are  the  most  helpless  of  the  children  who  tend  to  live 
for  anv  considerable  time. 


CLASSllUATlUX    AM)   TKK.M  ]  XOI  .'JC.  V 


MENTAL  AGE  OF  NEW  ADMISSIONS.YEAR'0310, 


53 


S3  IDIOTS 


MBECILES 


iS  MORONS 


6     7     2    9   JO  II 


IZ  13  IH   IS 


_  TOTAL 

NaoF  CAsesyv  13  II   15  10    2    IS  IS  IZ  13    i     H     0    0    0  IH'O 

MALES/ 9 
'^. 1  »-/  FEMAl£S6i 


Noto. — Of  the  numbers  inflicatiiiK  mental  ago  1  moans  having  a  mentality 
of  1  year  or  under.  2  means  alM)v<>  1  year  hnt  not  over  J  years,  etc.  Thus  a 
child  testing  to  9^/2  years  is  inelnded  witli  the  lOyear  groui). 


i6 


IIACKWAKL)    AND    FEMBLK-MI  XDia)   CIIII.DKMX. 


Above  the  mental  age  of  ten  the  number  of  admissions  is 
seen  to  he  ahnost  negligible.  I'our  of  the  eight  who  arrived 
left  within  the  year.  Two  of  these  were  insane,  and  one,  an 
epileptic,  was  so  complaining  that  his  people  soon  removed 
him.     The  fourth  was  a  third-grade  schoolbov.  the  Initt  of 


I'ii;-.  11. —Tinder  odo  year  of  mental    age.     The   child   looking  np   is   one 
thiee  who  showed  the  least  mentality  of  all  the  children  tested. 


liis  town,  who  staye<l  l)nt  a  few  weeks.     Four  were  female 
sex  offenders. 

The  average  age  of  the  children  classed  here  as  idiots  was 
9.6  years  ;  of  the  imbeciles  it  was  12  years,  and  of  the  morons 
14.9  years.  But  one  idiot  was  over  sixteen  years  of  age; 
but  four  imbeciles  and  four  morons  were  over  eighteen  years. 
The  oldest  moron  was  thirtv-six ;  the  oldest  imbecile   was 


(1  ASSII-K    \  ril).\     AM)    ll-.R.M  I  NOLOCV. 


I'ortN -tiw,  and  llic  oliK'st  iclioi  was  l\\cm_\--scvcn.  ll  is  to 
I;c  noted  lliat  tlic  instilutii>n  discouraii"es  applications  for 
cliildrcn  that  arc  nwr  ci^litrcn.  interjiretinij^  its  function  to 
l)c  that  of  a  ,s'(7/0()/  for  chihh'cn  in  llic  formative  ])criod.  Mow- 
ever,  the  state  has  not  ])rovide(l  elsewliere  for  the  older  de- 
fectives, who  are  ver\-  numerous  and  ver\-  danu"ei'ou>  to 
society. 

l<lleven  of  the  new  admissious  classed  above  as  morons 
and  nine  of  those  classed  as  inihcciles  are  of  hiLjher  ^rade 
than  those  whom  llinet  would  send  to  s])ecial  classes  ou  ac- 
count of  retardation.  Two  of  these  showed  normal  intelli- 
,!4Tnce.  but  bad  serious  speech  defect  in  one  case  and  weak 
attention  in  the  other.  These  two  children  were  soon  dis- 
chari^'cd.  and  neither  would  have  come  at  all  but  for  dis- 
ruptions in  their  families.  I''ive  of  these  cases  are  e])ileptic, 
and  thus  tend  to  further  retardation.  Two  others  are  stated 
to  have  had  convulsions.  One  child,  with  but  a  vear  of 
retardation,  is  c;iven  to  thievin<4',  and  had  remained  four 
}ears  in, the  tirst  j.i'rade.  Another,  with  but  a  vear  of  retarda- 
tion, has  a  severe  nervous  affection.  Another,  retarded  but 
two  and  a  half  years  and  already  mentioned  as  lea\in^- 
early,  was  prematurely  l)orn  at  seven  months,  was  moralK' 
delinc|uent  and  an  "easy  mark"  for  his  fellows.  Still  another 
bo}',  with  but  one  and  a  half  vears  of  retardation,  was  sent 
b}-  a  Juvenile  Court  as  beiuQ'  violent  to  .smaller  children  and 
destructive.  He  is  incontinent,  and  has  spent  thrc'e  or  four 
years  in  the  first  orade.  Another,  a  colored  L^irl  of  illegiti- 
mate birth,  defective  in  s])eech  and  vision,  was  retarded  btii 
one  and  a  half  years  and  was  sent  here  for  running  awaw 
These  are  all,  or  ])racticall\-  all,  of  moron  i^rade. 

Of  these  hij^her-L;rade  admissions  wliose  \'oun^^er  \ears 
causes  theiu  to  be  classed  as  imbt'ciles,  one  is  a  bab\-  '^\v]  of 
three  and  a  half  Acars,  retarded  but  a  year  and  defective  in 
speech.      Another,   an   or])Iian    bo\-    of   eii^ht,   has    defective 


l8  i;.\CKUARD   AM)   F-EKIiLE-M  INDED  CTIir.DREX. 

vision  and  one  and  a  half  years  of  retardation.  Another 
orphan,  retarded  two  and  a  half  years,  is  defective  in  speech 
and  walk,  is  thieving  and  untruthful.  The  case  of  Harold 
R.,  an  aphasic  boy  with  sensory  defects  and  enuresis,  will  be 
described  later.  Two  twin  girls  with  speech  defect  are 
retarded  very  similarly  to  each  other,  and  to  the  amount  of 
about  one  and  a  half  years.  A  girl  wdiose  retardation 
amounts  to  two  and  a  half  years  had  remained  in  the  firsc 
grade  from  her  sixth  to  her  ninth  year,  and  had  an  immoral 
home  with  a  mother  who  is  feeble-minded.  The  last  of 
these  cases  is  a  girl  of  seven  years  who  shows  but  a  half 
year  of  retardation  in  intelligence.  She  is  an  orphan  who 
was  expelled  from  school  for  self-alnise.  She  is  defective 
in  facial  expression,  is  slovenly  to  an  abnormal  degree,  has  a 
chaotic  mental  span,  and  shows  marked  para-functionings 
in  speech,  writing,  drawing,  and  general  conduct. 

In  handling  these  cases  I  am  impressed  with  the  evident 
fact  that  the  amount  of  intellectual  retardation  may  some- 
times be  very  slight  and  yet  the  mental  defect  may  be  grave, 
fundamental,  and  often  incurable.  Prognosis  must  some- 
times be  reserved,  and  a  faithful  description  of  the  conditions 
found  is,  of  course,  a  better  record  than  the  affixing  of  any 
formal  labels.  Some  of  these  less-retarded  cases  are  more 
distinctly  of  the  feeble-minded  kind  than  some  who  show 
three  or  more  years  of  intellectual  retardation.  Of  course, 
they  usually  show  marked  retardation  in  functions  other  than 
the  intelligence.  Probably,  too,  their  intelligence  itself  will 
seldom  develop  past  the  twelve-year  limit  of  feeble-minded- 
ness. 

\\niile,  therefore,  it  may  usually  be  best  to  apply  the  terms 
idiot,  imbecile,  moron,  and  fechlc-iniudcd  only  to  children 
who  show  retardation  of  the  intelligence  amounting  to  ar 
least  three  years,  or  to  at  least  two  years  if  they  are  under 
nine,  and  wdiile  the  safer  rule  for  public  school  practice  niay 


Cl.ASSll'JCAIION    AND   Tl'-RMI  .\()I.O(  ;V.  \[) 

be  to  ap])l\-  these  tenn>  oiil)  when  tliere  i>  more  lliaii  tJircc 
years  {more  tlian  two  when  under  nine),  it  should  neverthe- 
less be  remem1)ered  that  the  use  of  tin-  terms  is  in  certain 
cases  am])]\-  jnslihed  when  iW-  retardation  is  of  less  deijree, 
and  such  children  ma\-,  \^  itii  perfect  warrant,  be  sent  to  insti- 
tutions and  confined  there  as  lon-^  as  seems  advisable,  li 
should  be  remembered,  too,  that  uiislabie  children  often  can 
be  best  cared  for  in  special  classes,  sometimes  even  in  in- 
stitutions, when  the  intellectual  retardation  may  be  ver}- 
sli,u,"ht.  I'.inet  found  that  the  unstobies  in  the  school  classes 
were  usuallx'  retarded  but  one  or  two  years. 

The  chart  in  J-'i;^'.  5  shcwvs  a  sii^niticant  ,^a])  for  the  men- 
tal ages  above  ten  years,  and  no  admissions  at  all  above  a 
mental  age  of  twelve.  Such  children  would  be  freelv  ad- 
mitted, but  they  did  not  ])resent  themselves.  There  is  no 
doulit,  however,  that  the  higher-grade  defectives  are  still 
more  numerous  than  the  lower.  .Arrest  occurs  at  all  stages 
of  growth  to  luatiH'it}-,  and  even  be\'ond  it,  since  there  is  a 
growth  c_\-cle  for  the  whole  life-period.  The  English  tables 
show  that  the  retarded  become  more  numerous  in  ])ro])or- 
tion  as  the  degree  of  retardation  is  slighter.  Indeed,  in 
England  the  generalization  has  been  made  that  in  an\-  coun- 
try there  is  a  certain  degree  of  mental  strength  which  is  of 
greatest  frequency  of  occurrence,  from  which  as  a  mean 
the  curve  representing  the  numbers  who  are  bt'tier  and 
worse  endowed  falls  away  regularly.  At  o])])osite  extremes 
of  this  curve  occur  the  idiots  and  the  men  of  great  talent, 
being  fewest  of  all  in  numbers.  '!'he  defectives,  according 
to  this  formulation,  are  thus  more  nuiuerous  as  in  tlieir  men- 
tal capacity  they  approach  this  normal  mean.  Tredgold's 
tables  of  frequency  for  idiots,  iiubeciles,  and  morons  bear 
this  out  in  a  general  wav. 

Without  insisting  on  this  theoretical  jjosition — and  it  will 
evidently  need  revision — we  know  that  the  zone  of  Ijordcr 


20  BACKWARD   AND   F1-:1-:IU.E-.MIND1-:D  CIlir.DKKN". 

defectives  is  a  very  populous  one.  Not  only  that,  but  it  is 
pretty  well  agreed  that  here  is  our  most  dangerous  class  of 
defectives,  presenting-  to  society  the  problems  that  are  hard- 
est to  solve  of  all  the  problems  of  defect.  Dr.  Fernald  even 
identifies  the  whole  class  of  instinctive  criminals  with  the 
high-grade  defectives,  and  considers  all  of  the  latter  to  be 
potential  criminals.  We  know  that  jirostitutes  are  recruited 
by  thousands  from  such  defectives,  and  that  the  recipients 
of  public  relief,  as  well  as  the  petty  trouble-makers  that 
pester  comnnmities  and  courts,  belong  in  large  part  to  the 
same  classes.  Above  all,  it  is  the  zone  of  marriageable  de- 
fectives, often  more  fertile  than  normal  persons,  who  are 
breeding  tainted  human  stock,  and  who  are  hel|)ing  largely 
in  the  spread  of  our  most  terrible  diseases. 

Evidently,  then,  it  is  of  first  importance  that  we  shoukl 
study  the  high-grade  defective,  and  that  we  should  obtain 
good  clinical  pictures  of  the  various  types  of  border  cases. 
One  may  begin  with  the  normal  and  work  down,  or  with  the 
feeble-minde<l  and  work  up.  In  the  Paris  clinics  I  had  been 
studying  adults  who  showed  various  slighter  degrees  of 
retardation  in  the  forms  of  neurasthenia,  hvsteria,  epilepsy, 
and  sometimes  of  dementia  ])raecox.  .-Xt  Lincoln  T  at  once 
selected  thirty  of  the  "brightest"  children  to  be  found  in 
the  institution,  for  clinical  observation  and  test.  The  school 
principal  and  others  who  knew  the  chiUlren  well  co-operated 
in  making  this  selection  :  and  while  the  search  was  not  ex- 
haustive, there  is  reason  to  Ixdieve  that  these  children  were 
about  as  near  to  the  normal  as  any  group  of  approximately 
school  age  that  could  readily  be  gathered  from  the  1300 
inmates.  A  few  substitutions  were  made  as  acquaintance  pro- 
gressed, and  tile  list  was  increased  to  thirty-two.  Several 
have  run  away  from  the  institution,  or  have  been  removed 
by  friends.  The  majorit}'  have  no  homes  or  have  abnormal 
home   conditions,   or   they   would   not   be   here.      However, 


ci.Assii'icA  ri(i\   AM)  'n:RM  i.\()i.o(;\'.  21 

the}'  arc  i^ood  rcprc^cnlaliws  oi  in>l  llic  t_\i)r>  that  are  t" 
be  fouiul  111  i_;rea1  iiniiiher>  in  llir  lioiin-^  ami  schiii>Is  ami 
luvcnile  (nurts  dl  the  wliolr  cimntrw  Twn  ai>hasic  cases 
have  Ih'cii  added  Iroiii  the  new  admissions,  and  there  is  one 
case  from  tlu'  Johns  I  lonkins  1  )ispensar\-  serN'ici'.  We  shall 
first  present  these  thirt\-tive  cases  in  detail,  and  shall  then 
tal)iilatc  some  of  the  data  ohtaineil  in  the  stud\'  of  them. 
Reference  to  the  latter  tahles  max-  ht-  made  as  t!ie  cases  are 
studied:  and  the  sxUahus  of  examination  which  was  used 
with  these  cases,  with  the  description  of  the  I'linet  tests,  mav 
well  he  looked  over  before  the  case  studies  are  read,  ddiis 
syllabus  is  ])rinted  in  a  later  cliapter.  in  usinu;  these  studies 
the  data  obtained  by  observations  and  tests  made  at  the  in- 
stitution itself  are  naturalh'  more  to  be  relie<l  ujion.  in  most 
cases,  than  the  home  record  fnrnishe(l  1)\-  ])arenls.  L^uanlians, 
and  others.  1  lowever,  the  ajjplication  blanks  which  ^ive 
most  of  the  home  record  are  signed  b\-  ])h\sicians  in  more 
than  (JO  per  cent,  of  the  cases,  and  whenever  •|)ossi1)le  the 
statements  have  licen  checked  b\'  information  obtained  from 
other  sources.  Tliis  part  of  the  data  must  !)e  taken  fi->r 
what  it  is  considered  to  be  worth. 


CHAPTER  111. 
CLINICAL  STUDIES  OF  BORDER  CASES. 


Fred  J.,  Ai^c  T-a'circ  and  One-half  Years. 

Fred  J-.  wlio  came  to  the  institution  in  March,  1905,  ar 
the  age  of  seven,  is  a  typical  and  lively  representative  of  the 
unstable  class.     (  )f  his  ]')eople  we  only  know  that  his  father 

deserted  the  family,  his  mother 
died  hefore  Fred's  admission 
here,  and  the  hoy  was  tai\:en  care 
of  for  two  years  by  the  Children's 
Aid  Society.  Thev  found  him 
quarrelsome  and  unreasonable, 
ill-tempered  and  destructive  ;  and 
reporting-  that  he  could  not  be 
kept  in  the  public  schools  turned 
him  over  to  Lincoln. 
Physical  examination  shows  F^red  to  be  of  about  normal 
weight  and  nearly  an  inch  below  in  height,  with  cranial 
measurements  that  are  very  little  below  normal.  He  has  .1 
normal  strength  of  grip,  but  his  lung  capacity  is  22  below 
il:e  no  cu.  in.  normal  to  his  age.  He  has  20/30  vision  in 
iiiO  right  eye  and  20/25  in  the  left,  with  normal  hearing. 
Flis  head  and  face  are  fairly  well  formed  though  with  some 
irregularity  and  asymmetry.  The  head  tends  to  be  held  to 
one  side,  the  nervous  control  of  the  mouth  is  somewhat  ab- 
normal, and  there  is  some  shuffle  in  the  walk.     Idie  medical 


CASE 

1.— Unstable 

and 

Quarrelsome. 

Energet 

ic  and  Coura- 

geous. 

Flighty     At- 

tention 

except    in 

Band 

Work.         De- 

fective 

Motor     Con- 

trol. 

{■|.i.\'ic.\r.  s'i'in)ii:.s  oi'  iiordi-.k  casks. 


record    contains   notliin^-    aj^ainsl    l''rL'cl    except    frosted    ears 
from  i)la\inj4' out  in  all  kinds  of  weather. 

In  school  h'recl  reads  onl\  lairl_\  in  the  ^ecniul  reader, 
does  simple  addition  and  snhtraction  and  is  learning-  the 
tables,  writes  in  a  scrawled  fashion,  s])ells  and  draws  only 
fairlv  and  does  inferior  work  in  manual  training.;'.  1  le  dances 
well  and  does  fairl\-  in  calisthenics.  Init  produce-^  nuich  dis- 
turbance. In  i^eneral  he  does  not  care  lor  "lirade  work," 
except  that  he  loves  drawing-  and  attends  well  thru  the  half- 
hour  of  this  exercise. 

In  spite  of  such  a  record,  l-'red  is  a  mat^azine  of  energy 
for  work  and  for  mischief,  for 
trouble  and  for  service.  Rest- 
less, active,  warm-heartedl}'  de- 
voted to  those  who  are  kind  to 
him  and  who  interest  him.  he 
is  indiii'erent  to  others  and  to 
all  hum-drum  tasks.  His  teach- 
ers says  tliat  he  ])unches  the 
other  children  and  is  even 
"brutal  to  them.""  lie  bosses, 
teases,  and  terrorizes.  "All  the 
boys  knuckle  to  him.'"  Me  can 
whip  any  bo\-  who  is  not  a  ia;reat 
<leal  larger  than  himself  and  he 
promptly  does  so  on  occasion. 
He  is  explosive  in  all  that  he 
does,  ordinaril)-,  and  his  worst 
school  fault,  beside  inattention, 
is  said  to  be  "smartness""  and 
"feeling  his  own  importance.  ' 
Kis  teachers  agree  that   when 

any  work  is  being  given  in  class  Fred  is  briefly  but  intensely 
interested  and  curious,  then  leaves  it.    He  works,  wliile  inter- 


FRED    J. 


24  l-.ACKWARl)   AND   1'EI-:15LK-A1 1  NDKl)  Clill  .DKKN. 

ested,  "twice  as  much  as  others."  lie  is  intent  on  the 
teacher  until  he  gets  what  he  thinks  to  lie  the  main  facts, 
then  will  not  attend  to  details  or  remainders.  Left  with  a 
task  lie  woiks  till  he  gets  the  first  problem,  then  leaves  the 
rest,  and  he  has  a  "bad  disjjosition  about  the  thing  turned 
down." 

Music  does  some  remarkable  things  to  this  explosive  and 
inattentive  boy.  In  a  year  he  has  learned  to  play  first  cornet 
regularly  in  the  institution  band,  and  is  as  steady  and  as  sure 
as  a  clock  in  taking  his  parts  at  the  right  time  and  in  the 
right  manner.  His  inattention  and  explosiveness  seem  to 
mellow  into  thoughtful  seriousness  and  controlled  adapta- 
tion under  the  influence  of  harmon\-  and  melodv.  He  is  re- 
liable and  is  continuously  devoted  to  his  nuisic  and  to  his 
nuisical  instructor,  and  makes  entircK-  normal  progress  in 
this  direction.  His  instructor  states  that  he  "will  learn  a 
new  selection  as  rapidly  as  a  normal  child  of  the  same  age"  ; 
and  that  Fred,  with  I'elix  X.,  (leorge  J.,  Vincent  C,  David 
¥..  and  Casper  H.,  "have  learned  to  play  such  selections  as 
Marflia.  U'cddiin^  of  the  Jriiids,  Chiincs  of  Noniiaiidy, 
and  (■lilted  Xatioii.  with  six  rehearsals  from  Alondav  to 
Wednesday  of  the  same  week,  half-hour  rehearsals  dailv  at 
8.30  A.  M.  and  hour  rehearsals  daily  at  2  P.  M." 

In  free  play  in  the  gymnasiu.m  I'^red  shows  exceptional 
spontaneity  and  good  intelligence  in  trying  out  and  inventing 
"stunts,"  and  he  is  perhaps  abnormallv  courageous  and  dar- 
ing in  promptly  taking  any  risk  to  carry  out  anything  sug- 
gested, seeming  to  be  without  self-consciousness,  as  well,  in 
the  doing  of  it. 

The  Binet  examination  gave  Fred  a  mental  age  of  ten, 
with  a  retardation  of  one  and  a  half  }cars.  Fie  showed  a 
weak  attention  span  and  was  very  distractible.  He  could 
not  repeat  five  munerals,  could  not  make  change  for  four 
cents  out  of  twentv-five.  coidd  onlv  define  ])\  tellin"'  what 


ci.i  x  iCAi.  siri)ii;s  oi'  noi^DCk  casi-'.s.  25 

thinj^s  arc  for,  could  not  tell  what  one  -should  do  in  any 
situations  thai  \vci\'  not  wry  concrete,  tailed  to  construct 
a  sentence  that  would  use  three  -^iven  words,  could  not  de- 
tect the  nonsense  in  sill\-  statements,  and  was  unahK'  to  re- 
arrano^e  sentences  ot'  ei^ht  words  when  the  words  had  l)een 
shuPtled.  l!is  s])eech  is  (|uite  defective:  lie  ])ronounced 
"exstrisity,"  for  "electricit} ."  "twooly-woowal"  for  "truly 
rural."  '"rawel"  for  "roxal,"  "awis"  for  "Irish."  "hied"  f()i' 
"hread."  etc.  h'or  "She  couldn't  do  that  herself,  could  she." 
l^'red  said  "COuldn't  do  dat  own-self,  cou.ld  'em?"  lie  ])icks 
up  scissors  and  e\erythin<4-  in  reach,  to  the  detriment  of  the 
task  in  hand. 

The  written  tests  (see  the  tahles  with  (lescri])tion.  foUow- 
intj"  the  clinical  studies)  show  a  handwriting-  that  is  irregular 
and  infantile,  hut  it  can  he  read,  d'he  lines  are  not  ])arallel, 
there  are  no  capitals  or  jnnictuation  marks,  the  i)age  is  ex- 
tremely unpresentable  and  is  apt  to  l^e  scrawled  with  rude 
drawings  and  other  markings.  'J'old  the  stor\-  of  "The 
Ivfarble  Statue,"  he  showed  interest  and  wrote 

"One  day  a  man  side, 
I   wold  give 
antler  thin 
in  the  wold 

If  you  was  a  live." 

Told  the  story  of  "The  Straw,  C'oal,  and  llean,"  lie  rejinv 
duced  some  matter  that  had  no  connection  with  the  storw 
and  then  added  only  "(  )ne  da_\-  3  of  then  run  a  wax  and  tlu' 
clod  (coal)  fall  in  the  Wdiit  (water?)."  .\sked  to  write  of 
a  tri])  in  a  tlying  machine,  the  sum  total  of  the  "stor\"  was 
that  the_\-  were  "glad  to  get  home."  Asked  to  mark  all  the 
A's  distributed  at  intervals  in  lists  of  ])rinted  capitals,  he 
made  a  very  large  nnmlier  of  omissions,  but  showed  good 
im])rovement  with  ])ractice.  .Asked  to  write  the  oj)])osite 
of  each  of  twent\-  words,  he  succeeded  with  but   four  words 


26  BACKWARD   AXD  FEEDLE-?>nXDED   CIIlLDRElSr. 

in  each  of  two  dift'crenl  lists.  Asked  to  write  words  similar, 
in  meaning',  to  twenty  more,  and  given  abundant  illustra- 
tions, he  succeeded  with  two  in  one  trial  and  nine  in  an- 
other. He  seemed  unable  to  keep  his  mind  on  the  conditions 
of  these  problems,  though  trying  to  give  attention  and  un- 
derstanding the  directions.  He  would  even  himself  suggest 
illustrative  examples  and  then  fail  in  the  test  that  followed. 
As  opposites  he  gave  big — short,  white — red,  happy — mad. 
like — love,  war — cold,  many — much,  above — love,  bad — daw 

Asked  to  indicate  the  points  of  the  compass,  Fred  marked 
north  correctly  and  then  made  inconsistent  errors  amounting 
tc  one  hundred  degrees  for  east,  seventy-four  degrees  for 
south,  and  twenty-nine  degrees  for  west.  His  errors  for  the 
directions  of  Chicago,  Springfield,  the  institution  farm,  and 
the  Lincoln  Court  House  averaged  twenty-four  degrees  and 
were  more  consistent.  Given  the  photographs  of  nine  of  the 
best-known  institution  buildings  and  asked  to  place  them 
in  their  proper  relative  jM^sitions  on  a  rectangular  table-top 
representing  the  institution  grounds,  he  showed  preliminary 
confusion,  but  finally  placed  seven  correctly.  Asked  tO'  im- 
mediately say  the  first  word  suggested  by  each  of  one  hun- 
dred selected  words  ])ronounced  to  him  singly,  fifty  at  a  sit- 
ting, Fred  failed  to  react  at  all  for  thirty  of  the  one  hundred. 
This  seemed  to  be  maiiily  due  to  his  inability  to  attend  for 
the  coming  stimulus  word.  He  woidd  be  full  of  something 
else  at  the  moment  when  the  word  was  given,  would  wake 
u|)  and  try  his  best  to  "think,"  then  with  a  disappointed, 
child-like  little  smile  would  wriggle  and  give  it  up.  He 
would  grow  progressivel}-  more  restless,  though  trying  his 
best,  and  I  had  to  keep  using  devices  to  get  his  attention. 
When  his  attention  was  sharp  he  usually  reacted  and  the  time 
was  then  short,  down  to  1.2  second,  while  his  median  time 
was  two  seconds. 

But  even   when  seeming  to  attend,  sometimes,  no  word 


CI. IN  It  Al.  STUDII'.S  ol'  r.oKKI'.K  CASES.  2^ 

would  coiiic.  Merc,  as  often  occurs  with  these  children,  the 
attention  was  prohaljly  to  ///<•,  a  i)ersonal  attention,  rather 
than  the  ])re])crceijtivc  wanning-  u])  ol'  associative  material 
which  would  have  been  the  essential  of  adequate  attention  to 
the  task. 

h'ift\-seven  of  the  se\ent\  reactions  made  were  sins^^le 
words  naturalK'  related  to  the  stimulus  word:  seven  showed 
the  inferior  relationshi])  of  mere  sound,  and  six  more  showed 
at  least  alliteration  or  similaritx'  of  ending;".  hCur  were 
merelv  usual  associates  in  spoken  utterance.  There  was  no 
perseveration  or  stereiitypy.  out  of  hearing-  hein^-  "out  of 
mind"  for  h'red.  Xot  even  a  reminiscent  constellation  was 
awakened,  apparently 

h'red  evidentl\'  fatigued  c]uickl_\-  in,  these  and  in  an\'  experi- 
ments that  involved  attention  to  thino's  at  all  abstract,  llis 
extreme  restlessness  as  the  written  tests  ])rot;"ressed  amounted 
to  contorsions  and  the  most  ludicrous  devices  to  relieve  him- 
self, wdiile  still  desiriui;-  to  keep  my  .i^ood  opinion,  lie  sorted 
fiftv  cards  into  five  ,<;roups,  bv  colors,  in  ei.ti'htx-two  to  ninety 
seconds,  keeping-  within  these  limits  for  four  successive 
trials.  lie  made  many  mimjr  errors  from  haste  and  l)a(l 
control.  His  forn.i  board  time  was  successiveh-  25.3,  -'3.5, 
and  18.8  seconds. 

On  the  eroograph  he  showed  his  tendencv  to  earh'  fatii^me 
by  making-  Init  two-thirds  of  the  normal  record  for  one  and  a 
half  minutes.  I  le  did  better  witli  the  dynamometer,  and  in  the 
test  for  continuous  t^ri])  thru  sixt\-  seconds  he  displa_\ed 
heroic  fortitude,  t^rittilv  permittino-  onh-  a  step-wise,  fairl\- 
regular  descent  from  fifteen  to  nine  kilograms  with  the 
right  hand  and  a  similar  descent  from  fourteen  to  six  kilo- 
grams with  the  left.  In  tapping  as  fast  as  possible  for  thirty 
seconds  Fred  fell  eight  short  of  normal  with  the  right  hand 
and  nineteen  short  with  the  left.  IbU  he  showed  remarkable 
lack  of  control,  drawing  his  face  and  bo(l\-  into  all  S(jrts  of 


2H  I'.AfKWAKl)    AM)    Fl-:i-:i!Ll-:-M  I  XDKD   CIl  ll.DREN: . 

shapes,  clianging'  his  method  frec|uentl\,  ta])i)ing'  so  heavily 
as  to  get  the  apparatus  out  of  shape,  and  showing  ahuost 
choreic  movements  during  and  after  the  ta])ping. 

Fred  waits  on  tahle  and  makes  himself  useful  in  a  variety 
of  wa\s.  He  has  "run  awa}"  a  time  or  two,  but  with  no 
effective  plan.  The  institution  as  it  is  at  present  can  scarcely 
hold  him  many  years.  lUit  he  will  always  be  defective  and 
in  imperative  need  of  guidance  in  the  use  of  his  super- 
abundant energy.  With  his  contempt  for  working  at  things 
that  do  not  stronglv  interest  him,  his  tendencies  to  violence, 
his  restlessness  and  his  fearlessness,  and  on  the  other  hand 
with  his  enthusiastic  warm-hearted  service  when  dominated 
bv  certain  influences,  he  presents  interesting  possibilities  if 
wise  direction  can  be  permanently  given,  and  dangerou-^ 
probabilities  if  it  is  not  given. 

The  secret  of  his  inattention,  instability,  and  inaljility 
to  submit  to  ordinary  discipline  lies  with  his  defective  neuro- 
muscular control,  so  evident  in  the  tapping  experiments, 
in  the  as}-mmetrical  mouth-tension  of  his  recurring  grin, 
in  the  iml)alance  <>f  holding  the  head  to  one  side  and  shuffling 
as  he  walks,  in  his  ever-restless  movements,  and  in  the  ex- 
plosive character  of  his  reactions  generally.  This  tendency 
to  explosive  discharge  masks  the  real  zccakness  of  his  nerve 
centers,  which  are  unable  to  inter-subordinate  each  other's 
activitv.  ])lacing  his  organism  wholl\-  at  the  mercy  of  what- 
ever functioning  "gets  the  floor"  for  the  time.  The  repre- 
sentations of  past  experience,  of  past  injunctions  and  es- 
pecialK'  of  more  or  less  abstract  principles  and  rules  of  con 
duct,  scantilv  possible  as  these  usually  are  in  defectives,  are 
powerless  even  wdien  brought  to  mind  in  the  face  of  these 
semi-convulsive  reactions  to  present  situations.  The  result 
is  conduct  that  cannot  long  be  subordinated  to  ends,  his  o\\  n 
or  of  others. 

Such  a  life  must  have  special  conditions  if  its  reactions 


CI.IXRAl.  STl'DIF-S  OF   |;()K|)1;k  CASES.  2<) 

arc  ever  In  he  liiike(l  up  and  co-ordinated  into  effective 
unities.  For  I'red,  one  of  these  con(Hlions  seems  to  l)c  musi- 
cal feehng".  which  seems  ahle  lo  hold  its  own  in  dominant 
control,  workini;-  hehind  the  scenes  to  mollil'\-  and  m()(lif\- 
all  reactions,  h'elt  haniiMU\-  and  melodv  are  donhtless.  on 
their  motor  side,  of  the  essence  of  synthesis  itself,  the  ver\' 
means  and  act  of  inter-suhordination  and  unitizins;-  of  other- 
wise disruptive  functi<inim^s.  We  need  not  then  lie  sur- 
prised at  the  wonders  they  sometimes  work  with  the  in-^ane 
and  with  defectives  generally. 

.Vnother  of  these  "feelino-charms"  is  the  s])ell  of  stor\ - 
telling.  More  potent  still  hecause  more  lasting  is  the  ])o\\er 
of  personal  affection.  The  "I'.esoin  de  direction,"  which 
Janet  finds  to  he  so  fundamental  with  the  neurotic,  re-^])onds 
gratefully  to  the  finding  of  the  first  real  friend,  he  he  k'reud- 
ian  physician,  hypnotic  counselor,  or  sym])athetic  music- 
master. 

Manual  work,  a  nuisic-roll  or  sled  or  pair  of  shoes  to  make, 
presents  an  outer.  ])ersisting  center  of  control  which  along 
with  the  personalit\-  of  an  efficient  instructor  tends  to  grad- 
ually introduce  more  of  unit\-  and  control  into  such  livc^. 
( iroup  work  in  which  the  thought  and  work  of  twenty  cen- 
ter in  the  same  line  of  conduct,  often  drowns  the  foil)les  of 
indi\'idual  fiightiness  in  a  social  attention  and  conduct  ihai 
has  been  the  making  of  man\-  a  l)o\-  in  arm\-  and  nav\-,  and 
that  is  effective  in  institution  work.  In  sum.  ['"reel  h;is  strong 
hut  ever-changing  interests.  To  control  them  and  him.  he 
needs  (  i  )  the  removal  or  i)revention  of  the  UKtst  serious  dis- 
tracting agencies,  by  provision  of  a  selected  environment: 
(2)  domination  by  personal  friendship  and  interest,  l)v  group 
projects  and  exercises,  by  feeling-work  in  music,  storv-tell- 
ing,  care  of  pets,  etc.;  (  _:;  )  work  that  centers  in  continuing 
and  interesting  objects  of  construction:  (4)  the  formation 
of   in\eterate  hnhifs  of  doiu"-  certain    useful   thiui-s   in   effi- 


30  BACKWARD   AND   FEEBLE-MIXDED  CIIIEDREX. 

cient  ways  at  proper  times.  Such  habits,  once  formed, 
greatly  lessen  the  need  of  attending,  and  help  to  direct  the 
attention  when  it  is  needed.  The  regularity  possible  in  in- 
stitution life  may  do  much  to  steady  such  flight\-  natures. 
\\'hether  the  nature  itself  can  be  permanently  modified  is  a 
problem  to  be  solved  by  such  institution  experiments. 


ci.iNK  \[,  srcDiMs  OF  i:()RI)i;k  casi;s. 


31 


CASE     2 

Unsta- 

ble.     Hered 

ity 

of  Al- 

coholism 

and 

Epi- 

lepsy.   Convulsions  in 

Childhood. 

Ta 

lented 

in     Music, 

whi 

e    De- 

teriorating 

in 

Intel- 

ligence. 

I'clix  A'.,  Aii^c  V our t ecu    Years. 

Felix  X.,  another  representative  of  the  unstable  class,  is 
a  l)oy  of  whom  most  conf1ietin<^-  o])inions  have  been  formed  : 
from  his  music  instructor,  who  believed  him  capable  of  l)e- 
cominq-  an  orchestra  director,  to 
his  attendant,  who  found  him  in- 
ferior to  boys  who  were  e\identl\ 
feeble-minded.     We  shall  see. 

Now  fourteen  years  of  ai;e, 
Felix  was  admitted  in  July,  KjO/. 
from  Chicago.  His  father  is 
stated  to  have  been  quite  intem- 
])erate  formerl\,  and  his  mother 
is    .said   to   have    been    alcoholic, 

epileptic,  and  immoral,  her  parents  dying  of  tuberculosis  and 
heart  disease.  T-'ive  lirothers  and  listers  died  in  infancv,  at 
least  three  dying  of  convulsions.  l'"elix  was  noticed  to  be 
peculiar  at  two  }'ears,  and  had  fre(|uent  convulsions  wlieii 
small  Init  fewer  as  he  grew  older,  the  last  occurring  nine 
months  before  admission,  lie  also  had  "sliglit  loss  of  con- 
sciousness" by  times,  lie  had  an  operation  for  abscess  on 
the  head  and  three  for  injury  to  the  knee  with  blood-poison- 
ing. 

b'elix  would  neither  stay  at  home  nor  go  to  school.  .Starting 
to  school  at  seven  }'ears,  his  school  record  was  \er\  unf.iv- 
orable.  Placed  in  an  imgr;;ded  room.  \\v  made  no  ])rogress, 
and  his  teachers  considered  that  he  could  not  be  taught  from 
books.  He  was  very  fond  of  animals  and  ver\-  susceptible 
to  kindness,  lie  was  with  some  boys  when  llie\-  stole  some 
beer;  and  as  his  home  was  unfit  the  |u\enile  Courl  directed 
him  toward  Fincoln. 

Physical  examination  finds  the  bo\-  six  ])ounds  abo\e  nor- 
mal in  weigdit  and  a  good  inch  above  in  height.     I  lis  cranial 


o- 


r.ACKWAKL)    AND    FEEBLE-MINDED   CIIILDKEN. 


circumference  is  sixteen  ninis.  above  the  normal  average 
and  he  is  well  above  in  lung  ca])acity  and  in  grip  of  either 
hand.  X'ision  and  hearing  are  normal.  The  forehead  is  a 
little  narrow  and  bulging,  the  face  is  not  entirelv  svmmetri- 
cal  and  its  expression  is  asymmetrical,  contracting  une(|uallv 
as  he  laughs.  The  palate  is  a  little  high,  the  ears  are  not 
symmetrical,    the    skin    is   pale.      The   medical    examination 

records  a  little  irregular- 
ity of  the  heart  and  of 
the  right  lung,  with  a 
slightly  enlarged  spleen. 
In  school  Felix  reads 
with  difficulty  in  the 
third  reader,  is  called 
"very  good"  in  spelling",  ■' 
calisthenics  and  dancing, 
but  has  difficulty  with 
the  multiplication  tables, 
lie  attends  normally 
along  the  lines  of  his  in- 
terests only.  lie  uses 
])rofane  and  obscene 
language,  and  bullies 
and  is  sometimes  cruel 
to  other  children. 

It  is  in  music  that 
h'elix  wins  distinction.  To  (|uote  his  instructor,  he  is  "rather 
a  genius  as  a  performer  on  the  cornet.  In  two  }  ears  he  has 
covered  about  live  years'  work  usually  allotted  to  a  cornet 
student,  has  perfect  control  of  embouchure,  tones  are  sure. 
velocity  very  rapid.  Plays  cadenzas  from  Bohemian  Girl 
with  perfect  ease  and  in  an  artistic  manner.     Plays  a  ballad 


FELIX    N. 


*TlTis  means  tliat  he  can  learn  a  "spelling  lesson"  well.     But  note 
the  examples  of  his  spelling  in  j)raclice. 


CLINICAL  Sl'CDII'.S  dl"   1U)K1)I:k  CASIiS.  33 

with  fceliiijL;-."  Me  "will  learn  a  new  selection  as  rapidly  'is 
a  normal   child   nf   the   same   ai^e." 

Mental  examination  with  Ih'net  tests  in  Jannary.  loio. 
,q-ave  T""elix  a  mental  aj^e  dI"  ten  and  a  halt'  \e;i,rs.  a  n'larda- 
tion  thns  of  two  and  a  half  vears.  Re-examined  in  jannary, 
I'O'i,  mider  \er\-  fa\'oral)le  eonditi<in>  and  wiih  mneh  care, 
he  conld  only  earn  a  mental  at^e  of  nine  and  a  iialf  years.  ,i 
retardation  then  of  fonr  and  a  half  vears.  Tliis  agrees  with 
the  reports  of  Ijoth  his  attendant  and  his  i)h\sician,  who  tin'! 
that  Felix  has  heen  "i^oino-  haek."'  hecdminj;  less  intellis^ent 
a--'  time  j^oes  on.  in  spite  of  his  e\-iden.t  progress  in  hand 
work. 

In  these  tests  h^elix  stated  the  month  (jannar\)  to  he 
Xovember  or  (  )ctober.  lie  showed  almost  eomi)lett'  cnn.- 
fusion  in  tryin.j;-  to  re|)rodnce  the  llinet  memor\  ])assat;e, 
and  at  that  he  conld  not  read  the  selection,  which  had  to  he 
read  to  hinL  lie  conld  not  constrnct  a  sentence  of  three 
given  words,  conld  not  detect  the  nonsense  in  sill\-  state- 
ments, conld  not  re])eat  seven  nnmerals  or  sentences  of 
twenty-six  syllables.  He  cc)nld  not  dehnt'  or  distin^in,>'n 
abstract  terms,  nor  dehne  at  all  exce])t  in  terms  of  nse.  ddie 
total  later  connt  shows  that  the  nnmber  of  tests  i)asse(l  was 
less  by  five  than  the  number  passed  a  year  before. 

In  the  written  tests  his  handwriting-  is  infantile,  llie  lines 
are  of  all  lent^ths  and  with  no  ca])itals  or  punctuation  iuark<. 
His  spelling-  is  most  fantastic,  e.  .q. :  Stachal  (statue).  >ad 
(said).  C()od  (could),  wone  (one),  hat  (hit).  i)ri\iu;;' 
(present),  shines  (machine),  arnalas  (animals),  derner 
(dinner),  ])ice  (]>iece),  1)en,yan  (be^an),  a  (and),  oui^-ht 
(out),  they  sawned  (  re])eatedl\-  for  "the\    saw""). 

Interested  in  a  stor\  of  two  children  who  wert'  allowed  to 
make  a  two-fla\-  tri])  in  a  simpU'  tl\  in^-macbine  ^i\en  tluMU 
for  a  Xmas.  present,  and  asked  to  write  of  what  these  chil- 
dren would   see  and   do.   his   stor\-    was   as    follows:      '"Sow 


34  HACKWAKD    AND   FEKBLE-MIXDED   CM  ILDKEX. 

day  starting  of  to  see  the  world,  so  they  was  g'oging  thay 
sond  (saw!)  a  hols  and  dichis  horsas  and  anialas  (animals!) 
so  thay  start  back  so  thay  got  back  home."  Asked  about 
"sond"  he  repeated  orally  that  "They  sawnrj  a  whole  lot 
of  dings,"  ap])arentl\-  considering  bi»th  this  spoken  and  writ- 
ten form  to  be  correct.  His  opposite  for  "bad"  was  "rnd" 
(rude),  and  when  the  test  was  further  explained  he  could 
only  give  "dirtv."  His  similar  for  "lightning"  was  "(lark- 
ing." Plis  total  ]ierformance  was  meager  in  all  the  written 
tests,  except  that  he  shows  regular  improvement  with  prac- 
tice in  marking  A's. 

helix's  control  of  his  feelings  and  of  their  expression  is 
distinctly  abnormal.  Tn  school  or  band  he  cries  on  slight 
occasion.  His  manual  training  teacher  reports  that  he  has 
"the  most  peculiar  disposition  of  any  boy  she  knows,"  that 
he  "gets  mad"  very  easily  and  then  wants  to  fight,  threatens, 
"will  kill  after  school,"  etc. ;  falls  into  a  pout  on  slightest 
occasion,  or  cries;  does  many  "little  simple  things,"  with 
"ways  of  a  three-\ear-old  child."  In  testing  him  T  noticed 
his  eyes  fill  with  tears  at  an  ill-success,  but  in  a  moment  was 
surprised  at  his  blurting  out  in  laughter  that  was  not  en- 
tirely apropos.  Ide  looks  up  brightly  at  me,  by  times,  as 
though  he  had  an  intelligent  "idea,"  but  his  following  sen- 
tence does  not  show  it.  His  whole  manner  as  well  as  his 
s])eech  are  most  immature.  He  may,  for  instance,  turn 
a\\a\  with  a  childish  grin  when  he  should  turn  to  you  and 
s])eak. 

We  have  here  an  inhibition  of  intellectual  and  social 
adaptations,  with  ]iersistence  of  infantile  characteristics, 
an  emotional  instability,  and  an  almost  or  quite  aphasic  dif^- 
cult\-  in  self-expression,  especially  in  writing  and  to  some 
extent  in  mimic.  But  in  music  this  boy  seems  to  tind  him- 
self. His  brain,  under  the  dominance  of  rhythm  and  of 
musical  feeling,  seems  able  to  organize  itself  and  to  have 


CLINICAL  STLmillS  OF  i;oki)i:r  cwses.  35 

some  (k'vclopincnl  tor  tliis  class  of  funcii()nin<;s.  even  while 
actually  deteriorating'  in  efficiene\'  for  the  everyday  work 
of  mind.  The  further  history  of  this  ease  will  he  watched 
with  interest.  The  latt'sl  word  as  1  write  is  that  his  "teacher 
reports  marked  im])r()vemeiU  hoth  in  work  and  dis])osition,'' 
while  his  physieian  sa\s  in  effect  that  hv  is  "not  (|uite  so  re- 
liable and  cries  at  the  least  re])roof.'"  1  incline  to  fear  the 
persisting'  effects  of  his  years  of  convulsions,  or  of  the  still 
operative  tendency  to  deterioration  which  earlier  expressed 
itself  in  convulsions. 


3^^ 


r.ACKWARD   AND  FEEDLE-MIXUED  ClIILUKEN. 


Folly  A.,  Age  Thirteen  Years. 


CASE  3. —  Unsta- 
ble. Family  History 
of  Insanity,  Alcohol- 
ism, and  Feeble- 
Mindedness.  Defect- 
ive Control  and  Ten- 
dencies to  Confusion. 


We  make  take  as  a  third  representative  of  the  unstahle 
group  Pollv  A.,  a  rather  dashing  girl  of  thirteen,  whose 
songs  and  other  parts  in  entertainments  have  made  her  well 

known  to  all  in  the  institution. 
She  was  admitted  in  1<P5  and 
re-admitted  in  1908  after  a  pe- 
riod of  ahsence.  Her  parents  are 
llel)re\vs,  the  father  a  Chicago 
teamster  in  good  health,  the 
mother  insane  and  stated  to 
have  hf  en  a  drunkard  during  the 
gestation  period.  Two  children 
who  died  earlv  are  stated  to  have  been  neglected  by  th<' 
mother  and  one  of  them  is  stated  to  have  been  deficient 
mentally.  The  three  who  are  living  are  in  the  institution  at 
Lincoln. 

The  data  about  I'olly's  ])re-institution  life  are  conflicting 
and  scanty,  but  she  is  stated  to  have  had  convulsions,  the  last 
in  1904.  She  was  in  school  several  years  with  '"no  result." 
She  was  irritable,  did  not  obey,  talked  foolishly,  wanderC'l 
awa} ,  and  ])laye(l  like  a  much  vounger  child. 

Physically,  she  is  nearly  fifteen  pounds  above  the  normal 
average  in  weight,  is  near  the  normal  in  height,  and  is  well 
above  it  in  lung  capacity  and  in  strength  of  grip  with  right 
and  left  hand.  Her  cranial  girth  is  thirt}-eight  mms.  above 
the  normal  average,  the  head  being  abnormally  broad.  Her 
hearing  is  normal,  but  her  vision  is  quite  defective,  one-fifth 
in  the  right  eve  and  four-sevenths  in  the  left.  Her  head  is 
fairly  regidar  but  is  U^o  broad  in  front  of  the  ears,  while 
the  face  is  not  of  (uiite  normal  shape  in  its  general  efifect. 
The  ears  are  unlike,  there  is  some  incoordination  of  the  eyes, 
and  the  outstretched  hands  show  lack  of  nervous  control. 


CM  N  ic.\[.  sTi'i)ri':s  ov  i'.okdi'.k  casks. 


37 


"J'lu'  iiic'(lu"il  c'xaiiiiiKition  tnnis  ;i  --mall  xriitral  luTiiia  and  a 
coiulilidii  of  tlic  i^enitals  sui^i^cstixi.'  of  bad  lial)ils.  f  )iIkm-- 
wise  her  physical  condition  is  said  lo  he  i^ciod.  jjer  home 
|)hysician  re])ortt'(l  a  "well  com])ensated  mitral  lesion." 

In  school  I'olly  i^ives  little  ironhle  on  the  side  of  disci])lin'.' 
and  i^ets  on  well  with  otiiers.  tho  sjie  In  loo  iid<4el\"  to  attend 
well,  and  a  (jiiick'  tem])er  is  state<l  to  l)e  her  "worst    fanlt." 
She  reads  rather  well  in   the   fi>nrth  reader,  i^encrallv  s])ells 
well,  has  much  difficnlt\'  in  doin>;'  l'»",U"  division,  draws  hadlw 
hnt  with  a  certain  dash  that  in- 
terests sometimes,      ller  hand- 
writin;^-  is   fair  Init   shows   had 
motor    control,    she    is   a    oood 
sewer,  dances  fairly,  but  is  too 
restless     to    succeed     in     calis- 
thenics.     She    is    studying-   ele- 
mentary    history,     jneoi^raplu', 
and  i)hysiolo^y,  with  only  \er\- 
moderate       ap])reciation       and 
progress,     and     she     is    takin;;' 
piano    lessons.      She    was    loo 
nervous  to  contiiuie  the  earlier 
piano  lessons,   using  her   limbs 
too  much  and  being  unable  to 
concentrate  even  sufficiently  for 
counting  or  the  observance  of 
rhythm.       Later    she    has    im- 
proved.    She  has  a  goofl  voice 
for  singing,  though   for  talking 
it  grows  hoarse  and  weak,  as  with  so  many  of  the  defectives. 
In   cantatas   and   other  entertainments   she  takes   her  parts 
with  a  charming  abandon  and  self-forgetfulness.     She  has 
a  wild  way  of  unconsciously  taking  series  of  attitudes  due  to 
successive  shiftings  in  her  nervous  balance,  the  effect  being 


roi.LY  .\. 


3o  BACKWARD   AND   FEEBLE-MINDED  CHIEDREN. 

to  add  interest  to  her  manner.  These  shiftings  may  be  of 
a  kind  with  a  distinct  tic  of  sighing  which  she  shows  from 
time  to  time. 

The  mental  examination  shows  a  mental  age  of  ten  years 
with  a  retardation  of  three  years.  The  most  signil^icant 
characteristic  revealed  by  the  varions  tests  is  the  distinct 
tendency  to  more  or  less  irrational  responses,  to  replies  and 
acts  that  are  only  partialh-  controlled  by  the  demands  of  the 
situation  or  by  the  notion  of  what  the  result  should  be. 
Asked  what  "goodness"  means  she  answers,  "Fill  this  world 
today — with  people  and  like  that — it's  all  right  ain't  it?" 
She  used  the  word  "skeld"  for  "skeleton."  Asked  to  dis- 
tinguish wood  from  glass  she  said,  "You  can  throw  glass 
on  the  floor  and  the  wood  can't."  She  says,  "The  number 
of  the  death  is  48,"  with  satisfaction,  meaning  the  "number 
of  the  dead."  She  is  "flighty"  in  giving  reproductions  of 
stories,  both  in  school  and  in  the  tests,  weaving  in  masses 
of  material  that  was  not  given.  (  )ccasionalh-  she  makes  some 
statement  that  she  cannot  "explicate"  even  to  herself,  a 
result  of  temporary  confusion  of  thought,  as  when  she  said 
"That  might  be  high."  when  I  ])roposed  taking  her  U])stairs 
to  weigh  her  and  measure  her  height.  Told  to  subtract 
she  may  arrange  the  problem  for  division.  The  troul)le 
is  not  merely  one  of  language:  ( )n  the  spirometer  she  can- 
not blow  slowly,  she  forgets  and  takes  a  second  breath, 
blows  before  her  lungs  are  nearly  full,  and  her  movements 
are  reckless  and  badly  controlled  generally,  though  with  best 
intentions.  With  distinctly  more  than  normal  strength  her 
tapping  rate  falls  well  below  normal  with  either  hand.  She 
picked  up  the  instruments  at  reckless  random,  nosed  into 
records,  and  generally  did  the  wrong  thing  in  irresponsible 
ways.  In  general,  as  I  have  suggested,  a  question  asked 
or  the  terms  of  a  situation  to  be  met  do  not  seem  to  remain 
innervated  to  check  out  incongruities  in  her  resultant  speecii 


CLINIC Al.  S'll'l)ll-;S  ol'   i;(»K!)i:k  CASI'IS.  39 

or  act,  and  tlu'sc  laltcr  arc  iiul  fell  as  maicliiiii^-  ov  failin,^- 
to  niatcli  tlic  ideas  lliat  ])roin|)t  tlicin.  I'lilikc  the  iiciiras- 
thenicall}-  unslaMc  she  is  ordinari!\-  not  at  all  troubled  l)y 
this  incongruity,  hut  mininiiniizes  ihe  importance  of  her  mis- 
takes. This  has  the  effect  of  distracting  attenlimi  from 
them,  and  l'oll}'s  persona]  charm  and  rather  winning  ways, 
with  the  devil-may-care  dash  of  her  \-ery  errors,  gives,  as  is 
often  the  case,  an  impression  of  grenler  abihtv  than  slie 
possesses.  Besides,  she  does  nuich  l)etter  at  some  limes  than 
at  others. 

The  written  tests  show  a  legible  but  irregular  and  some- 
what primitive  handwriting.  Her  mis-spellings  are  usuall_\- 
such  as  "to"  for  "ttjo,"  "their""  for  "there,"  "women"  for 
"woman,""  the  omission  of  possessive  marks,  the  use  of  the 
infinitive  for  past  tenses,  and  other  such  cliildisli  errors. 
Except  for  her  forgetting  to  write  certain  word-,  her  ])ara- 
graphs  make  an  abridged  sense,  sketchih-  as  a  little  child 
talks  or  draws,  and  she  sees  no  more  in  the  stories  told  her 
than  a  very  little  child  would  see.  iler  "flying  machine 
story"  is  essentiall}- :  "1  had  fine  time  xx  a  good  lime  xxx 
was  happy  xx  gave  little  boy  a  ride  xx  he  enjoyed  il  ver\- 
well  XX  thanked  me  and  I  was  nice  about  it  so  he  went  home 
I  was  happy  all  the  time.""  It  is  totally  colorless  and  "non- 
specific." 

(  )f  her  lOO  association  reactions  l)ut  24  are  found  in  the 
list  of  all  the  words  given  by  1000  normal  persons.  Sixl\- 
eight  are  phrases  or  sentences,  being  her  attem])ls  to  dcl'uw 
the  word  given  in  sjMte  of  cautions  to  react  with  but  a  single 
word.  Fifteen  of  these  "definitions"'  are  entirely  tautologi- 
cal, many  others  are  puerile,  and  there  is  little  Aariety  of 
response.     Note  the  following  given  in  succession  : — 

20.     Chair — What  \'ou  sit  on. 


40  BACKWARD   AND  FEKIUJi- MINDED  CIllLDKEN. 

21.  Sweet — Nice. 

22.  Whistle — You  blow. 
2^^.  Woman — A  lady. 
24.  Cold — Freeze. 

2^.  Slow — Real  slow. 

26.  Wish — \o\\  wish  somebody  something. 

2"/.  River — Water. 

28.  White — Nice  and  white. 

29.  Beautiful— -Purity. 

30.  Window — What  }ou    close. 

31.  Rough — Not  nice. 

2^2.     Citizen — (  No  reaction.     Word  unknown). 

2,2^.     Foot — \o\\  put  a  shoe  on  it. 

34.     Spider — What  crawls. 

Non-specific  words  anfl  phrases,  as  "nice,"  "prettv,"  etc., 
are  common  and  characteristic.  The  ])uerilitv  and  naivetv 
of  the  reactions  were  entirely  in  keeping  with  Poll)  "s  facial 
expression  as  she  looked  at  me  in  the  experimenting.  It 
was  to  be  noted,  however,  that  none  of  the  reactions  w'ere 
entirely  senseless  or  "bizarre."  They  were  more  or  less 
apropos  to  the  stimulus,  and  93  different  reactions  were 
made  in  a  total  of  96. 

Polly  mis-placed  seven  of  nine  institution  buildings  when 
a^ked  to  arange  their  photographs,  and  she  showed  almost 
no  knowledge  of  directions.  North  anil  south  were  almost 
interchanged,  though  she  lives  in  "South  Wing"  as  she  well 
knows.  Such  tests  as  the  form  board,  or  the  sorting  of  50 
cards  with  backs  of  5  colors,  were  carried  out  promptly,  the 
former  in  21  to  2"/  seconds,  the  latter  in  97  to  109  seconds. 
]>ut  wherever  the  problem  involves  the  manipulation  of  ideas 
confusion  is  sure  to  appear. 

More  recently  Polly  would  seem  to  be  deteriorating  some- 
what :  it  is  stated  that  she  "foroets  what  she  is  to  do"  anil 


CLINICAL  S'rii)ii;s  oi'  i:()K|ii;r  casks.  4I 

■"sits  rather  stupidly."  I 'nl(;rliinately,  tou.  iiiis-k-d  1)\  Irt 
very  supt'rticial  '  hri^hlness."  elforls  are  l)ein^-  nuule  to  re- 
move her  from  llie  institution  and  to  ha\'e  her  sliare  t\)v  re- 
.sponsihihties  of  home-keeping-.  'Jhc  re>uU  can  liardl\-  l)e 
other  than  cusastrous  ;  and  vet  wlien  a  ])arent  insi>ts  the  in- 
stitution is  powerless. 


CASE  4.— Dull  but 
Pretty.  A  Feeble- 
Minded  Family.  Col- 
orless Reactions,  Fa- 
cile Type.  Weak 
Lungs. 


42  I'.At  KWAKl)    AXl)    FKl-:ilLl->  MINDED   ClI  I  [.1  )KI£N. 

Uliiiiic  P..  Age  Tzvcl-t'c  and  One-half  Vcars. 

Winnie  is  not  at  all  unstable,  but  she  does  not  know  very 
much.  She  is  placed  at  the  head  of  all  the  processions  of 
institution  children  because  she  looks  so  charming.     .She  is 

actually  a  very  good  representa- 
tive of  the  dull  group. 

Xovv  12J/5  years  of  age,  Win- 
nie has  been  in  the  institiition 
since  she  was  73^.  (  )f  her  hered- 
ity it  is  stated  that  bcjth  her 
grandparents  "drank  some"  and 
that  her  mother's  mother  was 
blind.  Her  own  mother  is  blind  in  one  eye,  or  nearly  so, 
and  is  !iot  of  strong  mind,  tho  fairly  healthy  and  earning  her 
living  as  a  domestic,  in  separation  from  the  father.  Of  the 
seven  children  three  were  stillborn  and  four  are  feeble- 
minded and  are  in  the  institution. 

Winnie,  the  youngest,  was  late  in  learning  to  talk,  showed 
no  interest  in  music  and  no  mechanical  ability,  was  good- 
tempered  and  obeyed  well  l)ut  remembered  poorly,  and  her 
teacher  reported  that  the  child  could  not  learn  anything. 

Physical  examination  at  the  institution  shows  Winnie  to 
be  II  pounds  l)elow  in  weight  and  nearly  5  inches  below  in 
height,  with  a  head  that  is  24  mms.  below  the  normal  girth. 
She  has  a  small  lung  capacity  and  her  grip  is  somewhat  lie- 
low  with  the  right  hand,  but  is  disproportionately  strong 
with  the  left,  as  occurs  with  very  many  of  these  children. 
Her  hearing  is  goofl,  but  her  vision  is  sub-acute.  While  her 
head  is  fairl}-  regular  the  face  is  not  entirely  symmetrical 
and  shows  an  unpleasant  irregularity  of  expression  about  the 
eyes,  seen  also  in  the  mother.  The  base  of  the  nose  is  low 
and  l)road,  the  palate  is  high  and  rather  narrow,  a  lower 
molar   is   almost  crowded   out  but   otherwise   the  teeth   are 


CI. I  NIC. \i.  S'iri)ii-:s  of  i;()KI)i-;k  casfs. 


_il;oo(1.  I  lie  ])al|)(.-l)i"al  ti>siirc  is  lari;!',  tlic  lilllc  tinL;i.r>  sliow 
an  abnormal  cnir\alurc,  the  skin  is  pale.  The  cliild  has  had 
pneumonia  and  severe  hrdnehilis  hnrderin^'  on  ])neunii)nia. 
several  times.  She  sIkjws  a  l(.'ndenc\-  to  tuberculosis  and  it 
will  ])r()l)a])l\  be  difficult  to  ])revent  some  such  earlv  culmi- 
nation of  her  respiratory  trouble. 

In  school  Winnie  is  still  in  kinderiiarten.  .She  docs  well 
the  simple  child  ^anus  and  exercises,  i^'ets  on  ver\-  well  with 
the  other  children  and  is  a  favorite  with  her  teachers.  She 
tells  little  untruths 
1)\-  times,  in  a  \(  mn^- 
child's  fashion  ;uid 
often  to  shield  others 
rather  than  herself. 
She  attends  as  well 
as  youui^-  normal 
children,  does  not 
do  or  sav  sill\-  or 
absurd  things,  ex- 
cels iu  jO'vuniasium 
work,  in  dancinj^', 
and  in  tlie  simple 
manual  work  of  the 
kindergarten.  S  h  e 
has  not  been  taught 
reading,  writing', 
spelling,  or  num- 
bers, is  slow  and  inapt  at  drawing,  and  has  had  no  other  work 
except  in  singing.  She  kn(jws  all  the  kindergarten  songs, 
l)ut  her  voice  is  so  weak  and  husk\-  tliat  not  nnich  can  be 
done  with  it.  She  is  without  originality,  takes  everything 
placidly,  and  her  teachers  state  that  her  worst  fault  is 
laziness. 

The  mental  examination  showed  a  mental  age  of  7  vears 


WLNMl';    I). 


44  I'.ACKWAKD   AND   FEEBLK-^riXDED  CHILDREN. 

with  a  retardation  at  that  time  <»f  4'/2  vears.  Her  speech  is 
iKirnial  l)iit  for  the  weak  and  hn>k_\'  voice.  She  was  nnable 
to  init  together  again  the  two  pieces  of  a  visiting  card  that 
had  been  cut  in  two  diagonally.  She  did  not  know  her  age. 
could  not  copy  writing  so  that  it  could  be  read,  failed  to  de- 
scribe pictures,  could  not  name  common  pieces  of  money  or 
make  change  of  4  cents  from  25  cents.  She  is  just  mentally 
dull  and  sluggish  and  is  not  troubled  about  it  either,  smiling 
sweetly  at  me  all  the  wdiile.  As  she  cannot  write,  the  writ- 
ten tests  were  beyond  her.  In  the  tests  for  orientation  she 
knew  south  and  west,  but  made  errors  of  nearly  90°  for  nortii 
and  east,  and  was  quite  at  sea  when  asked  to  point  in  the 
direction  of  well-known  places.  She  mis-placed  6  of  the  9 
buildings.  1  ler  tapping  rate  was  right  127,  left  117,  as  com- 
pared with  a  normal  173  and  146.  Her  form  board  times 
in  successive  trials  were  39,  33,  28,  27,  26,  20J/2,  22^2  sec- 
onds. In  both  tapping  and  form  board  tests  she  was  "as 
steady  as  a  clock"  with  never  a  sign  of  confusion  or  hurrw 
She  used  continuously  the  same  gentle  method,  followed 
directions  well  and  made  no  breaks.  Asking  her  to  make 
(|uicker  time  did  not  confuse  her  in  the  least.  The  steady 
reduction  in  time  in  the  form  board  tests  indicates  the  readi- 
ness with  which  her  mental  and  physical  activities  become 
aiifoiiuillc  rather  than  showing  ability  to  Icani.  The  tend- 
encies to  automatism  are  perhajxs  the  strongest  that  are  to 
be  found  in  the  feeble-minded  generally. 

Asked  to  give  words  similar  in  meaning  to  10  words  pro- 
nounced to  her,  after  the  fullest  explanation  and  with  all  the 
time  she  wished  she  succeeded  with  but  2  of  the  10.  (iiven 
too  association  words  in  two  sittings,  she  could  think  of 
nothing  at  all  for  40  of  them,  tho  knowing  all  of  the  40 
words  except  one.  Of  the  60  reactions  given,  42  were 
single  words  naturally  related  to  the  stimulus  words.  In  9 
reactions  she  showed  perseveration,  i.  e.,  the   repetition  of 


c'l.i.xu  Ai,  s'l  riiii.s  oi-  iU)Ki>i;K  casi:s. 


45 


earlier  reaetions.  Stieli  words  as  "black."'  white,"  would 
kee])  reeurrin.L:',  luil  not  so  ulU'ii  a,s  lo  convtiiuii.  th^.  ,-,tere(i- 
tvi)V  so  often  found  with  the-e  ehikh-rn.  ller  median  r<'ac- 
tion  time  was  \-er\'  slow.  4.1  seeondx.  She  had  too  mueh 
mental  inertia  to  s^el  the  wonls  out  e\en  when  the\-  did  occur 
to  her.  sonu'times.  At  other  times  she  would  harel_\-  utter 
them,  colorless  associations  at  that,  it  all  ,L;a\c  a  \i\id  jiic- 
tnre  of  a  low-level,  slu,^-.^-ishly  working-  mind  with  i^reat 
])aucit_\'  of  resources,  and  contentnienl  withal. 

It  is  the  case  of  a  child  whose  reactions  are  uniforml\- 
without  color,  the  reactions  tif  simple  delect  and  ])assi\-it_\' 
coupled  with  the  charm  of  a  doll-like  heautw  .Such  a  life 
passes  simply  and  ha])])ily  enou.^'h  in  an  institu.tiou.  I  hit 
unfortunateK-  she  ai)))ears  normal  to  the  inohserwuit  and  [0 
those  who  do  not  take  accoiuit  of  her  a^'e.  And  she  is  al- 
most certain  to  attract  some  would-be  i)hilauthropist  who 
will  take  her  out  and  eventually  let  her  ])ass  into  the  hands 
of  the  elements  in  societ\-  that  are  ever  on  the  lonkoul  for 
iust  such  facile  uirls  as  this. 


46 


BACKWARD   AND  FEEDLE-MIXDED  CUILDRF.N. 


Jcrrv  H.,  Age  Fourteen  and  One-half  Years. 


CASE      5. 

-   Dull, 

Sluggish,  an 

d 

Docile. 

Alcoholism 

in 

Fam- 

ily.      Weak 

M 

emory. 

Thieving,  but 

Gener- 

ally  Steady. 

Terrv  is  a  typically  dull  boy,  usually  but  not  invariably 
stable,  who  wins  the  aiit'ection  of  his  teachers  and  is  usually 
over-rated..  Now  14^  years  of  age.  he  has  been  in  the  in- 
stitution luit  a  }ear.  His  father 
is  stated  to  have  been  a  periodi- 
cal drinker  and  to  have  whipped 
the  lK)y  in  times  of  temper.  It 
is  said  that  there  is  a  brother 
who  is  "not  bright."  jerry's 
mental  peculiarities  are  said  to 
have  been  noted  first  when  he 
entered  school,  and  the  cause  given  was  that  lie  was  "al- 
lowed to  drink  whisky  until  the  age  of  10  years."  He  was 
"subject  to  sore  eyes,"  but  with  good  health  otherwise.  His 
memory  is  stated  to  have  been  "very  poor,"  but  he  was  in- 
terested in  music  and  in  mechanical  construction,  tlio  he  had 
a  tendency  to  hide  and  destroy  things  and  was  not  very  good- 
tempered  or  obedient.  The  mother  died  and  Jerry  lived  in 
an  Orphans'  Home,  and  makes  vague  statements  about  liav- 
ing  had  some  schooling  there. 

Phvsicallv  Jerr\  is  18  pounds  below  normal  in  weight  and 
3.3  inches  below  in  height.  .His  cranial  girth  is  normal  and 
his  strength  of  grip  is  nearly  so,  tho  his  left  hand  has  a  dis- 
proportionate strength.  In  the  spirometer  test  he  falls  32 
l)elow.  He  has  but  two-thirds  of  the  normal  acuteness  of 
either  eve  or  either  car.  The  head  is  high  behind  and  there 
is  slight  asymmetry  and  irregularity  of  head  and  face.  The 
base  and  middle  of  the  nose  are  low  and  broad,  the  front 
teeth  below  are  impacted  and  abnormally  long,  but  the  teeth 
are  otherwise  quite  good,  d'he  hard  palate  is  narrow  and 
perhaps  a  little  high.  The  eyes  are  very  prominent,  the 
mouth  is  open  much,  there  is  a  slight  drooping  of  the  left 


CLINICAL  sTUDii'is  OF  i:()KI)i:k  casi-:s. 


47 


shoulder,  the  walk  is  shiggish.  The  medical  examination 
gave  Jerry  a  clear  hill  of  health,  noting-  onl}-  some  fine  ner- 
vous tremors. 

Tn  school  jerry  has  a  clean  record  on  the  side  of  morals 
and  discipline,  gets  on  very  well  with  the  other  children,  at- 
tends "normally,"  does  not  make  silly  or  incoherent  roplie-^, 
is  docile,  amiable,  the  favorite  l)o\-  in  the  room.  Indeed  ho 
is  a  pet  and  trusted  helper  of  his 
teacher,  who  when  asked  f(^i" 
Jerry's  worst  fault  reports  th.it 
he  "has  none." 

However,  on  the  side  of  sch.ol- 
arship,  this  box-  of  14' j  is  ])lo(l- 
ding  with  dii^culty  thru  eas\- 
first  reader  lessons,  is  just  he- 
ginning  multiplication,  and  is 
doing  work  in  drawing  ordina- 
rily given  to  very  much  younger 
pu])ils.  He  does  best  in  indus- 
trial work,  is  learning  to  dance, 
and  some  simple  stor\-  work  and 
calisthenics  complete  his  sched- 
ule. 

The  mental  examination  gives 
jerry  a  mental  age  of  8^2  years 
with  a  retardation  of  5J>-2  years. 
His  speech  shows  primitive  char- 
acteristics,   such    as    the    use    of 

"(ley"  for  "they,"  "mudder"  for  "mother,"  etc.,  tho  he  can 
articulate  all  the  test-words  given  him.  He  could  never 
repeat  five  numerals,  could  not  count  tlu'  \'alue  of  six 
stamps,  could  not  count  from  20  to  o,  could  not  co])y  .1 
phrase  dictated,  did  not  know  the  da\'  and  date,  could  not 
make  change,  failed  to  name  some  of  the  ordinary  i)ieces  of 


.IKItKY    II. 


48  BACKWARD   AND   FEEBLE-MINDED  CHILDREN. 

money,  and  could  think  of  but  31  words  in  three  minutes. 
When  there  was  read  to  him  a  short  news  item  giving  about 
19  "details"  about  a  fire  and  he  was  immediately  asked  to 
tell  of  it,  he  could  only  recall  that  there  was  a  "fire.' 
Questioned  then  as  to  each  detail  he  could  recall  a  few,  but 
with  inaccuracies.  He  tries  honestlv.  l)ut  says,  "It  leaves 
my  mind."  He  tells  me  that  he  would  go  to  the  store  for 
articles,  but  would  forget  what  he  started  for  and  would 
have  to  return,  tho  he  would  keep  repeating  the  name  of  the 
article  to  help  remember  it.  If  he  stopped  saying  it  over 
it  "left  his  mind."     He  says  that  this  often  happened. 

Jerry's  responses  show  nc^  absurdities,  he  gives  good  at- 
tention and  shows  a  fine  spirit,  with  politeness  and  consid- 
eration for  the  examiner.  But  he  shows  little  energy,  is 
■7rry  slow  to  respond  or  to  think,  his  mind  seeming  sluggish, 
doing  little  and  that  little  not  too  well.  His  eyes  filled  with 
tears  when  I  showed  dissatisfaction  at  his  recalling  so  little 
in  the  memory  test,  but  he  did  not  become  active  even  in  his 
emotion  and  it  quickly  disappeared.  He  showed  no  signs 
of  nervousness,  no  twitching  or  excitement.  By  times  he 
would  }awn  or  sit  with  mouth  o])en.  and  no  thoughts  would 
come.  (  )n  the  play  ground  he  can  ])lay  well  enough,  but  he 
hangs  back  and  does  not  think  of  things  to  do.  Left  to  his 
own  resources,  however,  he  stimetimes  shows  spontaneity 
and  even  imagination,  as  when  I  suri)rised  him  ]ilaying 
"Ofifice"  with  another  ben-  and  using  bits  of  paper  for 
"letters." 

In  the  written  tests  he  writes  a  fairly  legible,  child-like 
hand,  using  no  capitals  or  marks.  He  wrote  nothing  for  the 
first  stor}-  or  for  the  flying-machine  test,  sitting  as  if  para- 
lyzed. Trying  to  rci)nKluce  the  ".'^traw.  liean,  and  Coal 
Story."  he  wrote:  "(  )nce  these  nos  olse  tvonen  to  get  stro\v 
iill  u  i  the  fire  cnel  str()w  fell  down  and  out  and  bean  ju" 

Trie<l  \\ith   Burt's  al])habet  test,   in   which  one   complete 


'  CI.INICAI.  STIIDII'IS  OF   l!(  )KI)I".K  (ASICS.  49 

iilphabet  is  i)ickc(l  in  order  from  two  shul'tkMl  ;Lli)lialK'ts. 
Jerry  did  not  kimw  all  the  letters.  \\\  showing-  liini  the  form 
of  the  letter  needed  he  was  able  to  do  this  test  in  5  minuti'-. 
lie  sorted  50  eards  to  5  i)ile>  in  limes  that  were  ])ro^r(.-s- 
siveh'  lowered  from  120  to  lOcS  seconds  in  six  trials.  Simi- 
larly he  made  the  (|niek  form  hoard  times  of  20.2.  i().4.  [()./, 
16,  15.2  seconds  in  successive  trials,  almost  e(|nalin^'  the  ])e,'- 
tormance  of  an  alert  physician.  lie  ta])])eil  \\ith  e(jual 
steadiness,  the  count  heini;-  172,  \()/.  165  with  the  ri^lit  han<l 
and  14(),  150,  150  with  the  left,  the  normal  hein^i  Iv  1S7 
and  L.  162.  In  these  three  latter  tests  he  had  the  little  intelli- 
gence necessary  to  grasp  the  method,  and  seemed  to  do  them 
with  the  automatic  regularity  of  a  clock  and  with  as  little 
tendency  to  become  ruffled  or  excited. 

Ierr\'  mis-placed  4  of  the  <;  buildings,  and  his  errors  foi' 
north,  south,  east,  and  west,  respectively  50 ',  124°,  2S '.  and 
15°,  showed  not  only  ignorance  of  direction,  hut  incongruitv 
of  thought,  lie  had  little  notion  of  the  direction  of  known 
points.  The  tests  for  similars  and  opposites  seemed  bexond 
his  ken.  Some  "similars"  written  were  love — pauta,  tobacco 
— stank,  tent — knite,  big — like,  lie  came  to  do  fairly  well 
in  the  A-test,  as  automatic  work  was  again  in  pla\-. 

Given  100  association  words  he  at  tirst  gave  a  numl)er  of 
intrchifcd  words  in  times  of  1  to  I '/j  seconds,  api)arently 
misunderstanding  the  test  and  instantly  giving  a  word  chosen 
in  advance.  Later  he  gave  phrase  or  sentence  definitions 
pretty  uniformh-  in  s])ite  of  repeated  cautions  to  react  with 
a  single  word.  Thirteen  of  these  were  tautological  and  most 
of  the  rest  were  colorless  and  over-sim])le,  showing  his 
poverty  of  mental  resources,  but  with  good  attention  alwaxs. 
He  showed  some  perseveration  and  some  reactions  that  were 
governed  bv  sound  instead  of  meaning.  Some  consecutive 
reactions  were  as  follows : 

81.     Ride — Ride  a  horse. 


50  UACKVVAKD   AND  Fi:i-:ULE-iM  I  XDJiU  CHlLDKEiN. 

82.  Thirst — When  you're  thirsty. 

83.  Thumb — Means  your  thumb. 

84.  Ill — Whenever  you're  cross. 

85.  Marriage — Whenever  you  get  married. 

86.  Grandmother — Means   whenever   you   got   a  grand- 

mother. 

87.  Rich — Whenever  you  got  lots  of  money. 

88.  I'ad — Whenever  you're  bad  in  school. 

Jerry's  attendant  re]3orts  him  to  be  "the  greatest  thief  on 
the  ward,"  perhaps  an  exaggeration,  and  says  that  Jerry 
keeps  a  particular  place  to  hide  things  taken.  He  adds  that 
one  cannot  believe  anything  the  boy  says  and  that  he  semi- 
occasionally  says  foolish  things,  as  when  having  a  blood-shot 
eye,  he  told  the  doctor  that  he  got  shot  in  the  eye.  In  spite 
of  his  general  mildness  he  has  occasional  outbreaks  of  tem- 
per, and  one  cannot  always  count  on  the  stability  of  even 
these  most  "stable"  children.  The  type,  however,  appears 
in  the  data  given. 


ci.ixuAi.  srriiii:s  or  r.oKDi-.u  casics. 


Bcrllui  ./.,   .  I i'c   Thirteen    Years. 


CASE  6.— Dull  and 
Docile.  Mild  Emo- 
tionalism, Paucity  of 
Ideas.  Most  Grace- 
ful  Dancer. 


Bertha  is  another  of  tlu'  t\i)icall\-  (hill  ehildren  with  little 
that  is  positive  mentally  or  niorall\.  hut  with  a  fine  sense  of 
wliat  is  graeeful  in  physieal  movement,  and  a   readiness  to 
learn  in  this  direction  only.     Of 
Bertha's  famil\-  nothing-  has  heen 
learned.     She  was  for  a  lime  in 
an     industrial     school     for    .girl-, 
and    has    heen    at    Lincoln    since 
1904. 

Phvsically    she    is    of    normal 
height   and    6   pounds    ahove    in 

weight,  with  a  head  that  is  (^f  nearly  normal  girth  hut  that 
is  abnormally  narrow  in  proportion  to  its  length,  ller  lung- 
capacity  is  13  alcove,  her  strength  of  grip  is  good  hut  is  great- 
est with  the  left  hand.  Her  hearing  is  normal,  visual  acuitv 
is  one-half  in  the  right  eye  and  two-fifths  in  the  left.  The 
head  and  face  are  regularh-  formed,  the  lower  jaw  is  rather 
undeveloped.  The  skin  is  nuich  freckled  and  of  a  peculiar 
pallor.  She  was  anaemic  a  couple  of  years  ago.  but  has  im- 
proved, and  her  health  is  considered  good. 

In  school  Bertha  gives  no  trouble  in  morals  or  discipline, 
gets  on  well  with  others,  attends  well,  does  not  do  silly  things 
or  make  absurd  replies.  She  reads  only  fairly  well  in  the 
third  reader,  s|)ells  satisfactorily,  adds  and  subtracts  two- 
place  mnnhers  with  difficuUy,  and  is  learning  the  easier  lines 
of  multiplication.  Besides  she  takes  only  music,  physical 
exercises,  and  the  sim])le  manual  work  of  the  kindergarten. 
In  the  calisthenic  and  gymnasium  work  she  is  most  grace- 
ful and  is  even  a  leader.  She  learns  the  exercises  readily 
and  remembers  them  well.  She  is  perhaps  the  most  graceful 
dancer  in  the  institution  and  seems  to  have  a  real  tho  in- 
articulate sense  of  the  "poetry  of  ])hysical  movement.""     An 


52 


HACK  WARD  AND  FEEBLE-MINDED  CHILDREN. 


earlier  teacher  of  drawing-  found  her  "artistic""  in  her  at- 
tempts at  free  hand  drawing  as  well.  Her  piano  teacher  re- 
ports her  to  be  a  promising  pupil  in  music. 

Mentally  she  tests  to  a  mental  age  of  9,  with  3  or  4  vears 
of  retardation.  She  could  not  count  from  20  to  o,  could  not 
tell  the  day  and  date,  could  not  make  change  or  name  the 
commoner  pieces  of  money,  etc.  In  the  written  tests  her 
handwriting  is  neat  and  legible,  but  like  that  of  a  little  child. 
Asked  to  reproduce  the  story  of  "The 
Marble  Statue,"  which  she  had  just 
heard,  she  writes: — "A  young  man 
made  a  studeyu  out  of  sund  and  it  sude 
on  grund  and  it  was  a  perttry  girl." 

In  the  other  tests  she  showed  a  simi- 
lar paucity  of  resources  and  of  expres- 
sion. She  could  give  scarcely  any  op- 
posites  or  similars  even  when  tested 
orally  and  alone.  In  the  A-test  she  first 
failed  entirely,  then  omitted  45  while 
crossing  38  in  the  two  minutes.  In  the 
orientation  tests  she  had  little  notion  of 
the  direction  of  known  points,  made  a 
uniform  displacement  of  90  degrees  for 
points  of  the  compass  and  mis-placed 
7  of  the  9  buildings,  6  being  placed  at 
points  distant  from  the  correct  loca- 
tions. 

In  100  association  tests  she  remained 
meekly  silent  for  2^.  and  did  not  know^  the  meaning  of 
mutton,  citizen,  and  justice.  Perseveration  occurred  four 
times  and  stercotv])v  was  shown  in  six  repetitions  of  the 
word  (tress.  The  tendency  to  drop  into  an  automatic 
'"tempo"  of  reaction  was  shown  1jv  giving  10  reactions  at  her 
niedian    reaction   time,   2.4  seconds.      Her  associations   are 


BERTHA    A. 


Ci.lNICAL  STUlJli;S  OF  IIOKUKR  CASICS.  53 

characterized  h\  the  now   familiar  lack  of  color  and  ])overty 
of  resource. 

In  school  and  elsewhere  il  is  In  he  noted  that  I'.ertha  does 
not  vohniteer  re];lies.  She  is  apt  to  sit  stupidly  with  no 
thought  hut  to  do  automatically  the  thing  expected  hy  her 
teacher.  She  seldom  raises  her  eyes  from  her  Ijook  or  slate, 
confined  in  the  very  little  world  of  the  half-dozen  things  that 
she  knows  to  do  at  her  desk,  and  apparently  never  thinking 
heyond  these.  With  all  her  apparent  stahilitv  her  teachers 
state  that  her  worst  fault  is  that  she  "cries  too  much,"  one 
teacher  saying  that  she  "can  hardly  speak  to  her  without  her 
crying."  But  the  emotions  are  mild  and  fleeting,  and  the 
child  is  the  same  from  dav  to  dav. 


54 


BACKWARD   AXD   FKKBLE-M IXDED  CHILDREN. 


Robert  P.,  .Igc  Fifteen  Years. 


CASE      7. 

—  Dull. 

Unstable. 

Family 

History    of 

Alcohol- 

ism      and 

Insanity. 

Premature 

Birth. 

Convulsions 

until 

Admission. 

Flighty 

Attention. 

Agraphia 

Mis-spelling 

s. 

Any  one  who  sees  Robert  managing  a  ball  game,  rushing 
hither  and  thither  all  in  a  perspiration  and  dazzling  his 
oddly-assorted  team  with  the  lingo  of  an  accomplished  "fan,"' 

would  be  certain  that  the  boy 
was  unstable,  ^^'e  shall  see  that 
he  is  equally  dull. 

Robert's  father  is  stated  to 
have  l)eeu  very  intemperate,  and 
a  brother  was  insane.  Robert 
was  born  prematurely  at  7 
months,  was  sickly  then  and 
"never  had  good  health."  He 
had  convulsions  three  or  four 
times  a  week,  the  last  occurring 
in  ]\Iay,  igoj,  shortly  before  his  admission  to  Lincoln.  He 
was  considered  to  be  epileptic.  He  did  not  begin  to  talk 
until  more  than  two  and  a  half  years  of  age,  and  had  typhoid- 
pneumonia,  measles,  and  scarlet  fever.  He  went  to  school 
one  year  and  was  said  to  be  a  truant. 

Physically  the  bo_\-  is  of  about  normal  height  and  weight, 
but  with  a  cranial  girth  that  is  25  mms.  below  normal,  the 
head  being  12  mms.  too  short,  but  normal  in  width.  He  is 
normal  in  lung  capacity  and  in  strength  of  grip,  except  that 
the  left  hand  is  disproportionately  strong.  He  has  two- 
thirds  vision  in  either  eye,  with  some  strabismus,  and  his 
hearing  is  quite  defective  at  the  left.  The  forehead  is  re- 
ceding, palate  a  little  high,  uvula  small,  ears  very  large, 
separate  from  the  head  and  asymmetrically  placed.  His 
fingers  are  very  unsteady  when  extended,  he  perspires  with 
extreme  readiness,  etc. 

Medical  examination  records  that  he  has  had  chronic  dis- 
charge from  his  ear,  that  his  tonsils  are  enlarged  and  that 


ci.ixUAi.  .s'ruDii:s  ov  iioKhi-.x  casks.  :^; 

since  enteriii,^  llic  institution  lu-  lias  had  bronchd-pncunionia, 
measles,  and  otitis  media.  1  U-  has  no  record  of  convulsions 
since  connui-  to  I  .incoln. 


1U)P.KUT    1'.   AND    1»AVII»    F. 


Tn  school  Ro1)ert  reads  fair]\-  in  the  first  reader  or.'v, 
does  some  addition  and  subtraction,  hul  failed  on  5  X  -  and 
4X1.  He  does  well  in  calisthenics  and  likes  to  "lead.'" 
}4e  is  also  good  at  dancing  and  in  Ijasketry.  In  manual  work 
he  is  generally  quite  unsatisfactory,  only  working  1)\-  fits 
and  starts,  tho  occasionalh-  he  turns  in  and  works  hard  for  a 
time.  He  does  not  work  accurately  and  "complains  of  being 
tired  all  the  time."  In  other  school  work  he  is  said  to  be 
a  "hard  worker  for  a  time,"  "when  interested  in  something," 
like   iM'ed    |.      He  cotdd   learn   band   work,   btit  after  three 


56  r.ACKWAKD   AND    FEKP.I.E-MINDED  CHlrJJREN. 

months'  trial  he  had  to  be  dropped  iov  laziness  and  inatten- 
tion, lie  would  forget  to  come  in  at  the  right  place  with 
his  part  or  at  the  right  time  for  his  lesson.  In  playing  ball 
with  him  T  note  that  while  he  can  play  well  enough  his  energy 
and  interest  soon  nm  down,  he  keeps  throwing  too  low  from 
sheer  laziness,  with  no  enthusiasm.  He  is  generally  found 
to  be  inattentive  and  liable  to  distraction. 

Mentally  Robert  shows  an  intelligence  of  nine  years  with 
a  retardation  of  5^2  years.  His  speech  is  nasal,  but  he  can 
articulate  normally.  He  could  repeat  5  numerals  but  once  in 
7  trials,  could  not  count  from  20  to  o,  nor  make  change  of 
4  cents  from  25,  name  the  months,  detect  nonsense  in  sen- 
tences, or  give  6  of  the  19  details  about  the  "fire."  He  seemed 
to  be  bored  with  the  trouble  of  thinking.  He  did  not  make 
absurd  replies,  but  was  merelv  weak  in  his  adaptations  and 
at  the  same  time  rather  self-satisfied  with  them.  "Not  very 
hard"  was  his  characteristic  reply  after  utterly  failing  to  re- 
arrange the  shuffled  words  of  a  sentence,  upon  my  saying 
"1  hat's  pretty  hard,  isn't  it?"  Asked  to  try  further  he  made 
the  words  up  into  some  other  jargon  and  was  satisfied. 

In  the  written  tests  the  work  is  very  weak  both  in  quantity 
and  quality.  His  handwriting  is  irregular  almost  to  scrib- 
bling, tho  large  and  therefore  moderately  legible.  His  mis- 
spellings, as  in  some  of  the  other  cases,  suggest  a  form  of 
agrai)hia.  Examples  are:  Waunts  (once),  feiyend  mon- 
shewn  ( tiying  machine),  worild  (world),  that  (they),  wenet 
(twenty  or  fifty),  dooler  (dollar),  woomen  (woman),  hose 
(house),  she  shad  (she  had),  bencis  (beans),  frie  (fire), 
strae  (straw),  heir  (her),  cold  (coal),  sne  (saw),  sad 
(said),  goe  (go),  a  crose  (across),  stache  (statue),  uch 
(wish),  aand  (and),  chiikes  (cheeks),  rud  (red),  treind 
(turned),  buteuring  (beautiful).  There  are  many  others. 
Robert  occasionally  omits  words  needed  to  connect  his 
llioughts,  apparently  from  carelessness  or  forgetfulness  as 


CI.IMCAL  STl'blKS  Ol-    i;OkI)i:K  CASES.  57 

lii>  llidUi^lit  shows  logical  CDiitimiily  tlirudut.  I'.nt  Uktc  is 
scantiness  of  incinor\  and  of  .^cnrral  rcsonrccs.  lie  sim])li- 
fies  the  stories  lo  the  merest  sketches  ami  often  nhsse>  essen- 
tials, iiivin<4"  the  ini])r(.'Ssions  ol  a  \  er\  \oiniL;'  child.  1  he 
povertN'  of  his  iniamer\-  is  shown  in  his  stor\-  of  the  llyini^"- 
machine  tri|):  "d'hey  had  a  jjoI  with  some  cotiee.""  went 
"out  to  see  the  world.""  and  "had  a  line  lime."  covers  il  all. 
Rohert's  child-like  et^'Otism  is  well  seen  in  the  hall  ,i;ames, 
where  he  makes  himself  the  shining  tii^-ure  anion,";-  his  still 
less  gifted  mates,  and  ])lays  with  tremendous  swagger  and 
noise.  llai)|)il\-  he  has  hecome  enamored  of  shoemaking, 
and  has  heen  sticking  prettx  well  to  tlie  learning  of  this 
trade.  At  such  an  occupation  and  under  wise  direction  this 
bov  ma\-  he  habituated  to  a  life  of  useful  and  more  or  less 
contented  service.  Ihit  he  is  tricky,  and  if  left  to  shift  for 
himself  would  attain  to  very  different  results. 


CASE  8.  —  Dull, 
Unstable.  Feeble 
Mental  Span.  Adapt- 
ed to  Institution  Life. 


58  P.ACKWAUl)   AM)   FEEBI.K-MIXDED  CHILDREN. 

Dont  J/.,  Age  T7vciity-lico   Years. 

In  her  neat  miifurm  Dora  is  often  taken  for  a  steady-go- 
ing attendant.  She  is  a  good  example  of  the  way  in  which 
manv  of  the  more  stahle  higher-grade  children  may  grow 

into  the  ser\'ice  of  the  institu- 
tion. Unfortunately  her  stabil- 
ity disappears  in  the  presence  of 
the  opposite  sex.  and  her  dullness 
is  evident  whenever  her  routine 
of  life  is  varied.  Xow  22  years 
of  age,  she  was  admitted  9  years 
ago.  She  had  lived  in  ("hicago.  her  parents  were  dead,  she 
had  been  at  school,  was  very  nervous  at  times,  forgot  things 
readilv,  was  untruthful  and  "careless  of  herself."  No  more 
is  known. 

T'lnsicalh'  she  is  24  pounds  above  in  weight  and  an  inch 
above  in  height.  Her  head  is  12  mms.  below  the  normal 
girth,  being  abnormally  short  for  its  width.  Her  lung  ca- 
pacitv  is  45  cu,  in.  above,  and  in  vision,  hearing,  and  strength 
of  gri])  with  either  hand  she  is  normal.  The  palate  is  rather 
high,  but  there  is  no  other  abnormality  worthy  of  note  unless 
it  be  a  slight  strabismus.  She  is  subject  to  tonsilitis  and  at 
one  time  had  some  little  trouble  with  the  left  lung.  Usually 
she  is  in  fair  health  and  able  for  her  work. 

In  school  Dora  now  takes  only  calisthenics,  manual  work, 
and  music  :  but  she  had  had  grade  work,  has  read  in  the 
fourth  reader,  and  can  now  read  a  newspaper  with  mod- 
erate fluencv,  tho  her  reading  is  nevertheless  illiterate  and 
abnormal  in  character.  For  instance,  she  was  utterably  un- 
able to  ])ronounce  experience,  gaily,  charitable,  correclional, 
juvenile,  purpose,  and  was  unable  to  read  long  numbers. 
She  can  multiplv  and  divide  only  with  the  smaller  digits, 
and  fractions  are  quite  beyond  her.     She  could  not  tell  the 


ci.ixiCAi.  S'ii'i)ii:.s  oi'  i;(ti<i)i:k  casics. 


50 


cost  of  four  apiilc's  at  i  '  j  cents  ai)icc<.'.  She  m'i\'cs  her  teach- 
ers no  troiil)le  nn  the  side  of  morals  or  discipHne,  "cts  on  we'll 
witli  others,  and  attends  well  to  teachers  and  tasks.  She 
sews  well  and  ra])i(lly.  and  makes  nian\-  of  her  own  clothes. 
She  is  a  j^dod  dancer,  and  sometimes  leads  the  calisthenics 
class  thru  their  exercises.  .She  is  a  satisfactory  pu])il  on  the 
]>iano.  reads  hvv  music  well,  and  ])la\s  eas\-  selections  as 
part  of  the  pro^^ram  of  entertainments. 

The  r>inet  tests  yive  I  )ora  a  mental  ai^e  of  iO''j  \cars,  a 
retardation  of  ii'j  \ears.  She  will  ])rol)al)ly  ne\er  have  an 
appreciahly  hetter  nn'nd.  iler 
mental  "si)an'"  is  childishK-  weak, 
not  sufficient  for  the  repetiti<in 
of  5  numerals,  which  is  a  task 
normal  to  a  7-vear-old,  nor  fo-,- 
a  T6-syllahle  sentence,  normal  io 
a  6-year-old.  .\sked  to  sa\-  all 
the  words  she  could  think  of  in 
3  minutes,  she  "ran  out""  com- 
pletely in  ij/.  minutes.  Ahstracy 
tions  are  quite  hcN'ond  her.  .\sk- 
ed  what  cliarlty  is  she  said, 
"Aren't  the_\  the  i)eo])le  that 
come  here  to  look  after  things?'" 
"What  is  g'oodness  ?""  "Someone 
is  kind  to  vou."  .She  did  not 
know  the  word  jiisfiic  at  all. 
Asked  ahout  a  picture  of  a  man  and  l)o\ 
said  "The  humans  have  to  i)u]l  the  wai^on."" 

The  written  tests  show  a  normal  and  verv  fair  handwrit- 
ing' and  spelling".  Slie  occasional!\-  omits  a  word,  causing 
her  sentence  to  make  ridiculous  sense,  h'xcept  for  this 
her  composition  is  very  fair.  A  few  phra>es  such  as  "on 
her  returned,"   "hecanie  in   lo\e,"   surprise   the   reader.      In 


iM)i;.\    M. 
pullinsj  a  cart,  sh. 


6o  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

her  story  of  the  flying-niachine  trip  all  that  is  "new"  is 
"and  we  indeed  delighted  and  we  seen  some  beantifnl  sigh.ts 
on  are  tri])."  Her  total  outpnt  is  very  meager  indeed  in  all 
the  tests,  except  that  she  progressively  rednced  the  marking 
of  A's  to  automatism,  with  good  final  output. 

The  tendency  to  automatic  functioning  was  also  shown  in 
making  13  of  100  association  reactions  in  1.7  seconds  each. 
this  l)eing  her  median  time.  Eighty-three  of  the  one  hundred 
reactions  were  single  words  normally  related  to  the  stimulus 
word,  75  of  these  being  found  in  Kent  and  RosanotT's  table 
of  words  given  by  normal  persons.  She  shows  some  tend- 
ency to  give  w'ords  suggested  l)y  sound  rather  than  by  mean- 
ing, and  this  appears  also  in  giving  opposites  and  similars. 
Note  tall — tell,  thin — then,  war — warm,  many — any, '  for 
opposites,  and  tent — ten,  feel — fell,  winter — win,  big — pig, 
snow — now.  run — ran,  for  similars. 

She  made  no  error  in  indicating  the  points  of  the  compass 
or  in  representing  the  location  of  nine  buildings,  and  had  a 
fair  general  notion  of  the  direction  of  known  points. 

On  the  ward  Dora  is  a  trusted  and  useful  helper  in  the 
storeroom,  caring  for  the  children's  clothing,  helping  to 
wash  and  iron  the  finer  things,  w'aiting  on  table  and  having 
the  privilege,  for  the  latter  service,  of  wearing  a  special  uni- 
form. She  is  talkative  and  lively,  but  gets  disgusted  and 
angry  by  times  and  then  pouts  and  says  she  "has  the  blues." 
Her  sewing  teacher  reports  that  Dora  does  not  always  act 
normall}-  in  the  expression  of  her  feelings,  and  that  occa- 
sionally she  breaks  out  laughing  without  apparent  cause. 

Generally  she  is  satisfied  and  contented,  and  in  the  very 
simple  conditions  of  her  work  and  life  she  conducts  herself 
normally  and  correctly.  But  the  tests  show  a  fatal  weak- 
ness of  mental  control,  tendencies  to  confusion,  to  "losing 
her  head"  whenever  circumstances  are  a  little  complex,  or 
under  strain  and  stress.     With  her  instincts  well  developed 


l;i.i.\](AI.  si  iDii'S  ()!■  i;()UI)i;k  cases. 


6i 


we  should  expect  to  fnul  just  what  jijeneral  ohservali(jii 
shows,  a  j4"irl  wlio  is  ciuolii  malh-  uuslaljle,  at  the  uicrex-  of 
her  sexual  iustiuct,  al)sunll\-  nvcr-conscious  of  herself  iu 
the  presence  of  men  and  lia\in|L;'  to  he  watched  carefully 
when  the  latter  are  abonl.  She  was  taken  out  of  tlu'  insti- 
tution and  cared  for  in  a  family  for  a  while.  Hut  this  insta- 
liilitx'  made  it  necessar_\-  to  return  her  to  to  the  institution 
for  safety.  Even  here  she  gets  into  "disgrace  as  the  result 
of  flirting." 

Here  is  a  striking  instance  of  a  usefid  and  coniparati\el\ 
happy  life  1)eing  realized  in  an  institution,  1)\  suiting  th  ■ 
conditions  of  environment,  work,  and  stress  to  the  girks  men- 
tal level,  in  the  case  of  a  girl  who  if  she  lived  at  large  would 
certainh'  lie  a  menace  to  socictv  and  to  herself. 


02 


i:.\c  K\\  AKi)  AM)  fi:i:i;le-.mixi)i:d  cniLUKEN. 


iicorgc  /.,  Age  Si.vtccji  and  One-half  }'cars. 


CASE  9.— Neuras- 
thenically  Unstable. 
Epilepsy  and  Cancer 
in  the  Family.  Quar- 
relsome, Complain- 
ing, Thieving.  Reads 
Much,  and  Intelli- 
gence  Fair. 


George  is  about  the  brightest  boy  that  I  have  tested  in  the 
institution,  and  he  is  ahiiost  as  unstal)le  as  any.  But  his  in- 
stabihty  shows   some  special  characteristics  whicli  perhaps 

warrant    us    in    classing   him    as 
iiciirasthciiicallv   unstable. 

Admitted  three  years  ago.  he 
comes  of  Polish  parents  who 
lived  in  Chicago.  His  father  was 
an  epileptic  who  died  of  cancer. 
His  mother  died  of  pneumonia, 
and  he  has  a  brother  with  de- 
fective hearing.  George  had 
slight  losses  of  consciousness  or 
"fainting  spells."  but  was  not  thought  to  be  an  epileptic. 
He  was  "extremely  nervous,"  did  not  sleep  very  w^ell,  smoked 
cigarettes  and  chewed  tobacco,  was  addicted  to  running 
away,  was  very  ill-tempered  and  disobedient,  continually 
quarreled  with  the  other  children  and  at  times  threatened  them 
with  a  knife.  He  was  at  school  seven  years  from  the  age 
of  six.  Later  he  was  a  short  time  in  an  orphan  asylum 
where  he  could  not  be  retained  on  account  of  vicious  habits, 
and  so  was  brought  to  Lincoln. 

Ph}sically  he  is  about  15  pounds  below  in  weight  and  two 
inches  Ijclow  in  height,  with  a  head  that  is  14  mms.  below 
in  circumference,  being  too  sh.ort  for  its  width.  He  is 
somewdiat  below  in  lung  capacity  and  is  distinctly  inferior 
in  strength  of  either  hand,  lie  has  not  more  than  one-half 
vision  in  either  e}e,  but  his  hearing  is  normal.  The  upper 
incisors  are  separate,  Init  the  teeth  arc  good,  llis  skin  is 
palish  and  the  nutrition  is  not  ver\-  good,  dlie  neck  shows 
some  goitre,  the  tonsils  are  somewhat  enlarged  and  the 
cervical  glands  as  well,  and  he  is  recorded  a,-;  having  a  chronic 


ci.ixjCAL  sii'Dii'.s  ()!■  i;()krji:K  casi'-S.  63 

adenitis.     In  meeting  one's  gaze  the  faeial  expression  is  not 
normal. 

In  seliool  Georg-e  reads  readily,  tlio  with  many  errors, 
and  he  takes  many  hooks  from  the  hhrarw  reachng  some- 
times even  when  marcliing  in  the  hne-up  for  meals.  lie 
made  glaring  mis-jironnnciations  of  existence,  oeeasioiis, 
iiiieesfor.  contracts,  etc.,  hut  read  on  untronhled.  lie  does 
simple  di\-ision.  not  long  di\'ision.  and  he  can  work  die  ver\' 
sim])Iest  ])rohlems  in  fractions,  hut  all  with  a  strong  tend- 
ency to  confusion  and  inaccuracw  lie  does  not  ("(//■<■  ahont 
heing  accurate,  and  gets  hored  with  tests  that  call  for  ac- 
curacy. In  general  he  attends  hadlv  and  tends  to  leave  or 
slight  his  work.  Manual  work  is  well  executed  while  the 
teacher  is  "right  there,""  hut  is  deserted  when  the  teacher 
leaves.  He  sometimes  uses  good  intelligence  in  inventing 
puzzles  and  games  not  connected  with  his  work.  The  ho\s 
in  the  manual  room  seem  to  cater  to  him.  recognizing,  as 
they  often  do.  an  intelligence  superior  to  their  own.  I  lis 
manual  teacher  says  that  ( ieorge  '"talks  mcjre  intelligentl\ 
than  any  hoy  in  the  room,  ahout  histor\-  and  stories  and  own 
experiences,'"  tho  telling  a  good  man\'  things  that  are  not 
true,  hut  owning  up  when  caught,  lie  excels  in  drawing, 
hut  iinds  this  eas\  and  has  little  incentive  to  tr\-  hard. 

George's  handmaster  finds  that  this  l)o\-  learns  music 
just  about  as  a  normal  child.  In  a  _\ear  he  has  learned  to 
play  the  cornet  in  treble  clef  and  the  baritone  in  bass  clef, 
and  in  one  month  after  starting  with  the  clarionet  he  could 
])lay  several  easy  beginner's  ])ieces  and  had  learned  the 
chromatic  fingering  of  the  clarionet.  All  this  was  within 
the  year  ( if  band  w<  >vk. 

The  r.inet  examination  shows  a  mental  age  of  1  i  j/j 
years,  a  retardation  of  _| '  ...  years  at  the  time  the  tests  were 
made.  His  speech  is  slighth-  defective,  ])ronouncing  "d"" 
for  "th,"  etc.,  tho  the  tr()ublc  W(nd<l  s^cm  to  be  largeh'  func- 


64  BACKWARD   AND   FEEDLE-M INDED  CillLDREX. 

tional.  He  finds  an  abnormal  amount  of  difficultv  in  usini^ 
language  to  express  his  thoughts,  illustrated,  for  instance, 
when  he  said  "in  a  several  weeks,"  and  again  "I  didn't  in- 
terfere much  with — I  didn't  monkey  around  much  with 
medicine  and  things  like  that."  his  reply  wdien  asked  to  name 
certain  smell  substances.  He  followed  this  by  saying,  "Yon 
know  half  the  time  I  didn't  try  things  like  that."  For  "His 
neighbor  died"  he  said,  "The  death  reached  his  neighbor." 
Asked  how  he  felt  he  said.  "For  last  two  years  Fve  been 
feelin'  as  good  as  a  fish."  In  the  manual  room  \vhcn 
he  was  asked  why  he  made  certain  silly  movements  and  clap- 
pings, he  said  he  was  "happy  because  the  world  is  going 
around."  Of  course  these  errors  show  a  troubled  thought 
that  is  perhaps  one  with  the  troubled  language. 

The  written  tests  show  a  fairly  legible  handwriting,  tho 
the  letters  and  syllables  are  often  widely  separated.  Capi- 
tals and  punctuation  marks  are  often  omitted  or  incorrect, 
and  words  and  letters  are  omitted  by  times.  Fie  spells 
dindt  (didn't),  rite  (right),  jest.  (just),  slipt  (slipped), 
siad  (always  for  said),  through,  thrue  and  true  (threw), 
tialler  (tailor),  enouhg  (enough),  mountians.  Separations 
such  as  the  n,  g  rccii,  p  ast.  pas  s  ing,  occur  frequently. 
Except  for  his  forgetting  to  write  an  occasional  word  his 
composition  shows  logical  normal  sequences  thruout.  His 
invented  story  of  a  trip  in  a  flying-machine  dramatizes  the 
initial  situation,  quoting  the  speakers:  Thev  went  past 
fields  like  a  bird,  saw  cows  in  pasture,  farmers  in  the  fields. 
all  so  small.  A  forest  looked  lovely,  like,  green  carpet. 
Then  the  mountains,  where  great  birds  follcnved  them.  Then 
a  camp  for  the  night,  a  good  time  next  forenoon,  and  home 
again  by  evening. 

In  100  association  tests  he  gave  89  normalh  related  single 


ci.iMc  Ai.  SI  i'nii-:s  oi'  i;(iki)i;r  cases.  05 

words,  (J4  different  reactions,  ami  4  failurc-s  to  react,  with 
l)iit  OIK'  seiitrnce  or  plira^c.  Mis  median  time  was  1.7  sec- 
onds and  his  maximum  time  was  _V3  seconds. 

In  thi'  orientation  te^ts  l)ut  one  l)uil(hn<;-  was  mis-phicech 
and  his  errors  as  to  (hrections  were  not  tar  from  normal. 
He  i^ave  similars  correcth'  for  each  of  20  words  in  two  trials, 
and  I  I  and  10  o])])Osites  in  two  trials  of  one  minute  each. 
In  three  trials  he  ])roi^ressed  to  an  output  of  <;5  .\'s  cros>ed 
with  no  omissions.  To  10  words  L;"i\'en  orally  he  re>])onded 
with  correct  sinndars  in  rt-actions  of  1.0  to  3  sec'.)nd>.  In 
three  repetitions  of  the  same  "'similar"  list,  on  diflerent  days, 
he  made  a  numher  of  variations,  hut  no  errors,  llis  form 
hoard  times  were  successively  21.3,  24.5,  i»j  seconds,  alter 
two  practice  trials. 

Geori^e  shows  "nerve"'  and  j^rit  when  Ijuoyed  U])  1)_\-  social 
aj^proval,  as  in  the  L;\'mnasiuni  where  he  j^rittiiy  carried  thru 
"stunts"  that  w-ere  almost  hexond  him,  because  he  thought 
that  1  expected  tliem  of  him.  lie  s])eaks  to  me  with  a  self- 
conscious  and  somewdiat  ceremonious  air,  looks  to  see  if  ])eo 
pie  watch  liim  as  he  pla\s  in  the  hand,  and  is  at  all  times 
abnormally  self-conscious.  lie  usually  wears  a  dejecied, 
wronged  expression,  com|)Iains  a  great  deal  and  is  always 
dissatistied.  His  self-consciousness  and  his  fundamental 
aboulia  aggrax'ate  his  tn^ubles  with  language,  which  reall\ 
rest  on  a  difficult \  of  synthesis,  ddie  soeial  adaptation  in- 
volved in  talking  with  me,  the  simultaneou.s  sxnthesis  of  va- 
rious factors  social  and  linguistic,  are  too  much  for  his 
weakly-constituted  brain-mechanism.  The  hner  adjust- 
ments clog,  and  using  the  coarser  ones  he  lilurts  out  what 
comes,  feeling  that  he  lias  done  badly  and  vet  not  doing  the 
utterly  irrational  things;  for  he  is  checked  and  controlled, 
///  tlie  large,  by  the  representations  of  the  results  of  his  ac- 


66  ISACKWAKD   AND   FEEBLE-MINDED  CHILDREN. 

tions.  ]^e  is  therefore  by  no  means  irresponsible;  but  feel- 
ing his  unceasingly  bad  outcomes  he  is  perforce  one  of  the 
unsatisfied,  as  neurasthenics  constitutionally  are. 

He  complicates  the  situation  by  lying  and  especially  bv 
thieving.  C)ne  of  his  teachers  says  that  George  steals  from 
people  that  he  "has  it  in  for,"  and  not  from  certain  others. 
He  is  easily  "smitten,"  and  is  said  to  have  stolen  perfume 
and  "everything  he  could  gets  his  hands  on"  to  lavish  on 
one  of  the  institution  girls.  Last  year  he  ran  awav,  but 
after  enduring  severe  hardships  was  returned  by  the  police. 
He  is  still  determined  to  get  away,  tho  a  teacher  recently 
reports  a  "wonderful  improvement  in  both  work  and  dis- 
position," and  that  he  is  now  "always  smiling  and  pleasant." 

Here  we  have  one  of  those  difficult  natures  more  often 
classed  as  neurotic  than  defective,  but  who  are  much  of 
both.  Gifted  with  all  the  mental  functions  necessarv  for 
life  in  society,  these  functions  work  so  frailly  and  incom- 
pletely that  these  individuals  are  always  in  trouble  and  are 
always  making  trouble.  George's  brains  will  doubtless  float 
him  out  into  society  sooner  or  later,  and  we  await  with  in- 
terest the  additions  to  his  record. 


(  I.I.XU'AI.  Slll)li;S  Ol'   llOixDIiR  CASl^S. 


^•7 


U ester  A.,  Ai^c  Eii^^litccn  and  One-half  Vear. 


CASE 

10. 

—  Hyster- 

ically 

U  n 

stable. 

Pse  udo 

-  E 

pi  leptic 

Convulsions 

Asso- 

ciations 

by 

Sound. 

Mcsler's  attract ivc  \()ice.  her  ])r()minencc  in  school  enter- 
tainments, and  tlie  ])rol)leniatical  character  of  licr  "convnl- 
sions"  make  lier  the  center  i>f  mnch  attention,  .slie  has  heen 
in  the  institution  since  \<-)0=,. 

Her  mother  cooked  on  a 
(h'e(l,^x'-boat  and  is  stated  to  have 
l)een  intemperate.  ilie  father 
died  of  pneumonia,  and  the  child 
had  measles.  scarlet  fever, 
mumps,  pneumonia,  and  malaria. 
She  had  a  bad  temper,  destroxed 

clothing,  was  "sl_\l\-  disoheclient."  had  had  sex  habits,  and 
was  a  i^reat  talker.  She  was  in  an  (  )rphans'  Jlome  for  a 
short  time,  and  was  in  the  .State  Industrial  School  lor  ( lirls 
for  some  years  l)efore  bein^-  sent  to  Lincoln.  Wdiile  in  the 
Industrial  School  she  attended  school  for  three  \ears,  but 
reached  only  the  2(\  i^-rade.  She  sa\s  that  she  had  >ome  sort 
of  "spells"  when  still  with  her  mother. 

Physically  Hester  is  3  pounds  al)ove  in  weight  and  1.2 
inches  below  in  height,  with  a  cranial  ^^irlli  that  is  34  lums. 
below  normal.  !^hc  is  4()  cu.  in.  above  in  lunt:-  ca])acit\'.  and 
of  more  than  avera.ci'e  strength  in  i;ri])  of  either  hand,  i  ler 
hearing'  is  normal,  but  her  visual  acuit\-  is  but  one-half  in 
each  e}'e.  Her  uvula  is  diminutive,  her  hands  and  fmgei"-^ 
take  abnormal  positions  when  extended,  the  th\roid  shows 
an  over-fullness  and  she  states  that  she  was  formerly  treated 
for  g-oitre. 

In  school  Hester  takes  work  in  the  sewing-room  oid\'. 
She  writes  a  good  hand  and  reads  ordinarx  m.'iller  with 
readiness,  but  with  itlilerale  mis-pi-ouunciation<. 

The  mental  examinati(jn  gi\es  her  a  mental  age  of  10J/2 
\ears  with  a  retardation  of  S  \ears.     She  conld  not  chanu'e 


68 


BACKWARD   AXD  l-EEliLE- MINDED  CHH^DREN. 


4  cents  from  25,  defined  only  in  terms  of  use,  could  not  re- 
call 6  of  the  19  details  in  the  memory  passage,  could  think 
of  but  4(j  words  in  3  minutes,  giving  <;  successive  words 
which  ended  in  -//;^i^.  She  was  never  able  to  rearrange  the 
shuffled  words  of  sentences  nor  to  repeat  7  numerals  or  sen- 
tences of  26  syllables. 

In  the  written  tests  she  is  very  weak  in  capitals  and  marks, 

and  occasionally  forgets  to 
write  a  word  intended. 
Once  she  writes  "We  got 
a  fifty  dollars."  Usually 
lier  ])apers  are  neatly  put 
up,  with  regular  lines  of 
even  length.  Her  repro- 
ductions of  stories  are  mod- 
erately full  and  correct,  but 
her  invention  for  the  flying- 
machine  trip  gives  only : 
"Where  do  you  think  it 
took  us  to — we  saw  a  laut 
of  pretty  things  on  our 
way."  A  nufif  (enough), 
laut  (lot),  whean  (when), 
one  (  on  ) ,  are  practically  all 
the  mis-spellings  to  be 
found  in  her  written  work. 
In  the  orientation  tests 
she  mis-])laced  4  of  the  9  l)uildings,  and  her  errors  for  the 
direction  of  compass  points  and  known  points  averaged  68 
and  54  degrees  respectively.  She  could  give  but  6  of  20 
opposites,  but  gave  similars  for  16  of  20  words. 

The  association  tests  at  once  revealed  certain  character- 
istic tendencies.  In  24  instances  she  failed  to  react  at  all, 
partly  due  to  the  emotional  or  reminiscent  appeal  made  by 


HESTER    A. 


CM  xicAi.  STri)ii;s  oi-  i'.()R1)|-:r  cases.  69 

the  sliiiuilu>  wiird  or  ])\  some  ])i"ecc'(lin_o-  word.  I'roni  the 
same  causes  many  of  her  reactions  were  much  delayed  in 
time. 

Of  21  selected  extra  words  interspersed  in  the  Kent- 
RosanofF  list  of  100,  the  word  i-()iirtilsi()iis  caus(,'d  much  con- 
fusion and  a  reaction  time  of  10  seconds,  the  reaction  heiny,' 
''Can't  explain  any."  The  word  cscaf^c.  (  she  had  tried  to 
run  away),  j^axe  no  reaction.  S/^asm  i^ave  no  leaction  hut 
a  thoug'htful  look.  "Make  heliexe."  succeeding-  this,  wa-- 
simply  repeated  with  a  laui^h,  time  5J/_.  seconds.  (  )ther  re- 
actions showing"  similar  characteristics  had  a  sexual  refer- 
ence. While  she  showed  herself  able  to  react  in  i  '  '!>  seconds, 
her  median  time  was  3  seconds,  showint^-  the  fre(|uent  occur- 
rence of  the  above  or  other  disturbin^i;-  intluences.  Ihu  17 
of  the  100  Kent-Rosanoif  words  called  forth  words  found 
in  these  authors"  list  of  reactions  i^iven  by  1000  normal  ])er- 
sons.  l)Ut  22  reactions  in  all  she)we(l  a  natural  or  usual  re- 
lationship (tf  /;/('(?/;/'/; i^.  to  the  t;iven  word.  In  42  instances, 
on  the  other  hand,  the  word  qiven  was  obviously  sui;;<:;"ested 
by  its  similarit}'  of  souiui.  Examples  are  deep — steep,  moun- 
tain— fountain,  house — horse,  mutton — button,  hand — band, 
short — stork,  butterfly — butter,  sweet — heat,  whistle — fistle. 
The  last  is  one  of  the  hve  neolog'isms.  or  coined  words,  found 
in  her  reactions.  In  three  instances  she  merel\-  repeated  the 
stimulus  word.  These  inferior  ty])es  oi  reaction  are  supple- 
mented bv  others  such  as  dream — train,  ( iirls'  C'ottag'e — 
Cot,  with  louf^"  reaction  times  and  apparc'UtK'  connected  with 
repressed  constellations. 

My  attention  was  first  called  to  llester  l)v  tiudiui;"  that, 
tho  not  considered  an  epileptic,  she  had  suddenly  conunenced 
having  a  series  of  frequent  and  severe  convulsions  regularly 
reported  as  epilei)tic  in  character.  There  was  the  bitten 
tongue  and  every  appearance  of  the  convulsions  being-  gen- 
uine, and  on  one  occasion  she  was  reported  to  have  been 


/O  BACKWARD   AND   FEKl'-LE- .MINDED  CHILDREN. 

uncuiisciuus  for  over  two  hours  and  to  have  had  as  many  as 
21  convulsions  in  one  day.  It  was  noticeable  that  she  did  not 
injure  herself  much  in  falling,  that  she  showed  areas  of 
anesthesia,  and  that  the  attacks  could  l)e  made  to  cease  by 
threats,  or  by  changing  the  girl  to  another  building. 

On  investigation  I  found  that  some  weeks  previous  to  the 
beginning  of  all  the  attacks  she  had  a  fist-fight  and  hair- 
pulling  with  another  girl,  had  quarreled  and  called  names  a 
good  deal,  and  had  struck  an  attendant.  As  a  punishment 
she  was  kept  from  the  institution  picture-show  and  dance. 
She  grew  very  angry,  escaped  to  the  distant  "(iirls'  Cot- 
tage," and  violently  resisted  return.  Allowed  to  remain 
here  in  the  epileptic  ward,  she  commenced  having  the  con- 
vulsions, which  continued  when  she  was  transferred  to  the 
hospital,  but  which  ceased  when  she  was  allowed  to  return 
to  her  original  (juarters  and  standing.  There  has  been  no 
recurrence  after  many  months. 

Beside  local  anesthesias  noticeable  at  times,  Hester  shows 
a  self-conscious  and  abstracted  manner,  with  nervous  twitch- 
ings  under  excitement,  and  a  considerable  narrowing  of  the 
held  of  vision.  She  showed  susceptibility  to  at  least  light 
Inpnosis,  and  the  indications  from  the  association  tests, 
with  the  other  symptoms,  point  to  a  condition  of  hysteria. 
She  was  finall_\'  induced  to  talk  frankly  about  her  "spells," 
and  her  statement  was  essentially  "I  put  them  on,"  "I  did  it 
to  be  mean."  .She  claims  that,  sleeping  and  eating  with  the 
epileptics,  she  "caught"  the  convlusions  as  she  feared  she 
would;  and  that  her  first  attack  was  when  an  epileptic  in  a 
convulsion  jumped  on  Hester's  bed  and  frightened  her.  She 
claims  not  to  remember  what  she  did  in  the  attacks. 

This  case  illustrates  the  possibility  of  even  trained  phys- 
icians, familiar  with  epilepsy,  being  deceived  bv  the  symptoms 
of  an  h}  sterical  patient  who  is  herself  familiar  with  epileptic 


cr.TxiCAr.  STi:r)ir-.s  ok  r,oRni-.K  casks.  yi 

inaiiircslalions.  TIktc  is  of  course  the  remote  ])ossil)ilily 
of  g"enuine  epileptic  seizures  l)ei!ii;  occasioued  l)v  sucli  sug- 
gestion, l)ut  the  contlition  of  hysteria  tliat  is  actuall\-  indi- 
cated seems  sutfieient  to  account  for  the  ])henomena  re- 
]:)orted.  The  latest  reports  are  that  tlie  girl  continues  to 
do  well,  and  that  much  of  the  trouble  ma\-  have  l)cen  due 
to  her  not  having  enough  of  mental  occupation. 


.\(.K\\  AKD    AND   FEIilJLE-^t  I  XDED   CHILDREX. 


Minnie  (i..  Aqc  Sci'cntcoi  ]^cars. 


CASE  11.— Neuras- 
thenically  Unstable 
with  Tendencies  to 
Hysteria.  Urticaria, 
incontinence  with 
Cystitis,  Tubercu- 
losis. 


Minnie  is  one  oi  those  neiirasthenically  constructed  indi- 
viduals who  Ix^come  hysterical  on  occasion,  and  whose  de- 
fective growth  has  been  at  the  bottom  of  her  limitations  of 

l)od\'  and  intelligence  on  the  one 
hand  and  of  her  neurotic  disposi- 
tion on  the  other.     She  came  to 
the  institution  in  November,  1909, 
from  Chicago,  v.ith  little  of  fam- 
ily  and    personal   record   beyond 
the    statement    that    her    mother 
was    dead,   that    Minnie   had   al- 
ways been  incpntinent  and  was  so 
still,  that  she  had  disease  of  the  ears  and  some  troul)le  with 
the  skin  since  having  di])htheria  at  the  age  of  six,  and  that 
she  had  reached  the  fourth  grade  in  school. 

Phvsicalh'  Minnie  is  4.4  pounds  I)elow  in  weight  and  3.4 
inches  al)ove  in  height,  with  a  head  that  is  nearly  normal  in 
girth,  but  that  is  abnormally  short  for  its  breadth.  She  is 
well  above  in  the  spirometer  test  but  a  little  lielow  in  strength 
of  grip,  has  but  one-half  visual  acuity  in  the  right  eye  and 
very  defective  hearing  in  the  right  ear.  The  face  shows  some 
irregularity,  the  uvula  is  diminutive,  the  nails  are  very  short, 
the  chest  is  sunken,  the  back  is  constantly  bent,  and  there  is 
a  general  unbalance  of  the  body  with  the  lungs  cramped  by 
her  crouching  p(xsitions.  Tier  walk  is  stooped  and  defective. 
There  is  poor  peripheral  circulation  and  the  nutrition  is  not 
good.  The  vaso-motor  system  is  unstable,  with  marked  lo- 
cal variations  of  heat  and  cold.  There  is  irregular  occurrence 
of  the  reflexes  and  there  arc  areas  of  hypo-  and  hyper-esthe- 
sia.  The  medical  examination  shows  a  condition  of  pulmo- 
nary tuberculosis  with  chronic  myo-carditis  and  an  "exceed- 
ingly uustal)le  nervous  condition."    There  has  been  found,  as 


ti.i.\]c.\i.  sri'i)ii:s  ()!■  i;()K1)i:k  casks. 


73 


well,  a  c\slili>  which  ^c^ists  ircatiiK-iil  and  whicii  doiihtlcss 
aj'^gravatcs  ihc  enuresis.  She  has  also  liad  a  i)eciiHar  and 
variable  skin  affeclion  diagnosed  as  factitious  urticaria. 

.Minnie's  schixil  wnrk"  has  heen  limited  to  the  sc\vint;-rooiu. 
where  she  is  becomini;-  (|uite  coni])etent  in  scwini^'  and  eni- 
hr()ider\-.  She  attends  normally  ,i;ets  on  well  enou<;li  with 
others,  but  is  abnonnalK  sensiti\'e  to  rt'])root.  .She  reads 
with  case  an\-  ordinar\' 
printed  matter,  but  has 
never  learned  to  ninltiply 
and  (li\-ide.  She  writer  a 
ver\-  fair  and  normal  hand. 

The  l>inet  tests  give  Min- 
nie a  mental  ag'e  of  i  i  '  j 
years  with  a  retardation  of 
4><  years.  She  thouiiht  of 
and  named  i  i  i  words  in 
three  minutes,  told  the  time 
which  clock  hands  would  in- 
dicate if  interchanj^ed  at  a 
given  time,  gave  rhymes  to 
given  words  and  could  usu- 
ally tell  what  to  do  when 
asked  about  a  variety  ot 
emergency  situations.  She 
said  "iM-icndship  is  a  ])er- 
son  wlio  is  kind  t(T  one  an- 
other."   Apologizing  for  an 

incorrect  drawing  she  said.  "I'm  not  a  \'er\'  u'cind  straiuhter. 
of  cour.se."  She  showed  abnormal  fearfulness  and  ""edgi- 
ness"  aliout  anv  unusual  oecurreiice,  and  extrenu-  suggcsti- 
Ijilitv.  After  some  trouble  with  a  test  she  broke  out  with 
"Sometimes  I  get  so  stupid  I  don't  know  what  to  do." 

Tn  the  written  tests  she  crossed  81  and  98  A's  in  two  two- 


74  BACKWARD   AND   FEEBLE-MINDED  CHILDREN. 

niinule  trials,  and  succeeded  with  17  of  20  "similars"  in  one 
trial  but  did  Inidl}-  in  another  and  in  the  tests  for  opposites, 
and  .yave  rather  weak  reproductions  of  the  stories.  Punc- 
tuation marks  are  absent  and  capitals  are  usually  in  the  wrono- 
place  or  omitted.  She  causes  breaks  in  the  composition  by 
omitting  words  that  were  probably  present  to  her  thought  and 
would  be  expressed  if  she  were  talking.  She  also  writes  the 
wrong  word  by  times,  apparently  from  distraction.  When 
she  has  to  write  of  happenings  that  are  at  all  complex  she 
breaks  down  and  simplifies  the  matter  in  semi-incoherent 
statements.  lUit  her  thought  generally  progresses  thru  the 
story  in  sequence  as  things  occurred,  and  her  frequent  errors 
in  expression  seem  to  be  phenomena  of  confusion  and  of 
frail  power  of  synthesis.  She  seldom  mis-spells,  the  onh-  ex- 
amples being  fithy  (fifty),  on  (one),  and  way  (away). 

Minnie's  intelligence  would  suffice  for  better  results  than 
those  tabulated  if  she  were  not  so  fearful  of  doing  badly  and 
so  markedly  introspective  and  easily  confused.  She  grieves 
over  the  fear  that  she  may  be  feeble-minded  and  that  our 
tests  may  prove  this.  J'>y  times  she  breaks  out  with  infantile 
expressions  of  affection  for  those  about  her.  Unfortunately 
she  has  fallen  into  bad  sex  habits  and  does  not  have  a  good 
influence  on  the  younger  children  with  whom  she  preferably 
associates.  ■  She  has  a  habit  of  complaining  and  tends  to  a 
condition  of  hypochondriacal  neurasthenia  with  tendencies 
to  hysterical  dissociation,  and  without  sufficient  strength  of 
intelligence  to  furnish  the  needed  correctives.  Her  physical 
condition  is  most  serious  and  demands  permanent  institu- 
tional care.  If  her  body  were  strong,  her  intelligence,  tho  de- 
fective, would  doubtless  suffice  to  float  her  in  society  as  well 
as  does  that  of  manv  another  of  the  host  of  the  neurotics. 


ci.ixKAi.  s'iT"i)ii:.s  oi'-  i!()I<i)i:r  cases. 


/o 


Hculali  A'.,  ./;^t'  I'ijtccn   )'car. 


CASE  12.— Epilep- 
tic, Defective  Emo- 
tional and  Motor 
Control.  Gossipy  and 
Over  -  Religious. 
Writes  Creditable 
Stories. 


JJeulali  i>   a  rather  lypical  c])ik'|)lic,  l)ut  she  shows  some 
phenomena  of  liysleria  as  well,  and  wilhal  has  the  distinction 
of  heint;-  a  story-writer.     She  came  to  the  institntion  in  l'"el)- 
rnary,    1909.     The   home   record 
states  that  the  father  was  intem- 
])erate   and   ran   away   wlien   the 
child   was  a  baby.     The  mother 
died     of    diphtheria     and     heart 
tronble,     A  brother  who  died  at 
three  years  of  age  is  said  by  iien- 
lah  to  have  had  spasms.    The  lat- 
ter   was    kept    at    an    Orphan's 

Home  until  brought  to  Lincoln.  She  had  measles  and  scar- 
let fever  followed  by  mastoid  trouble.  She  also  had  epileptic 
convulsions  which  are  said  to  have  increased  in  f requeue}' 
since  an  operation  for  mastoiditis  in  .August,  1907.  She  at- 
tended the  regular  sessions  of  school  wdiile  at  the  Orphan's 
]  tome. 

Physically  Beulah  is  6y2  pounds  al)ove  in  weight  and  .3 
inches  above  in  height,  with  a  head  that  is  10  mms.  too  small 
in  girth.  1  ler  lung  capacity  is  38  cu.  in.  above,  she  is  some- 
what deficient  in  strength  of  either  hand,  has  but  two-fifths 
vision  in  either  eye  and  has  ver}-  defective  hearing  in  the  ear 
that  was  operated  upon. 

The  face  is  rather  infantile  and  shows  some  irregularity, 
probably  a  result  of  asymmetrical  muscular  contraction. 
The  teeth  show  some  irregularit\-  of  ])osition  and  the  lower 
teeth  are  nmch  crowded.  The  jaw  has  an  irregular  shape 
and  there  is  a  dimimitive. uvula  and  a  high  palatal  arch.  The 
ears  are  defective,  the  fingers  are  abnormally  tapered  and 
the  second  fingers  are  turned  strongly  outward.  The  fingers 
show  convulsive  mo\'cments  when  extended  and  spread. 


76 


BACKWARD  AND  FEEBLE-MINDED  CHILDREN. 


The  medical  record  shows  that  I'eulah  is  not  considered 
strong,  having  tendencies  to  bronchitis  and  gastritis.  She 
has  right  himljar  scohosis  and  "shght  huig  and  heart  in- 
volvement." She  continues  to  have  severe  convulsions,  and 
there  is  at  least  a  temporary  partial  paralysis  of  the  right 
side  of  the  face,  the  right  eye  being  abnormally  open  while 
the  month  and  lower  chin  are  drawn  to  the  left. 

In  school  Beulah  reads  fairly  in  the 
fourth  reader,  works  problems  in  divi- 
sion and  simple  fractions,  does  not 
s])ell  well,  is  fairl)  original  in  drawing 
but  <^loes  not  tinish  her  work  well.  She 
does  ])oorly  in  basketry  and  irregularly 
in  clav  modeling,  showing  originality 
in  the  latter  but  lacking  persistence  in 
the  face  of  difficulty.  She  does  badly 
in  calisthenics  and  dancing,  is  original 
in  story- writing  and  tells  stories  well. 
She  also  studies  history,  physiology, 
and  geography,  but  with  less  than  nor- 
mal ])rogress.  She  is  "very  quick  to 
see  thru  a  ]M-olilem,"  attends  well  to 
her  teacher  and  to  certain  tasks,  but 
often  sto])s  and  "looks  into  space," 
l)erhaps "making  u]:i  stories,"  her  teach- 
er suggests.  On  the  whole  her  teacher 
thinks  she  attends  fairly  well  "with  al- 
lowance for  dreams."  She  gets  on  well 
with  other  children,  and  gives  much  time  and  interest  to  the 
lliblc.  She  is  decidedly  inclined  to  gossip,  to  over-confiding, 
and  to  mild  com])laining  and  cr'ticism. 

The  mental  examination  gives  Beulah  an  intelligence  of  at 
least  12  years,  a  retardation  thus  of  not  more  than  2^  years. 
Asked  what  to  do  before  undertakinig  an  important  affair 


lUULAU    N. 


CLINICAI.  S'l'll)II':S  OF   nORDKK  CASES.  /J 

she  answers,  "Pray  and  think."  Clidrity  is  "hmnljlc  and  ri^ht; 
Uke  Christ."  She  gives  toq  words  in  ^  minutes.  I  kr  mental 
span  is  too  weak  for  j  numerals  or  for  sentences  of  26  S}'1- 
lables,  and  she  cannot  distiiii^nish  between  ah.-tract  terms. 
But  her  vivid  imagination  enable^  her  to  succeed  in  the  first 
of  the  pa])er-culting  ex])eriment>  ruid  to  maise  jirogress  with 
the  other  one,  and  her  interi)retatii  m  of  ])ictures  was  norniak 
During-  2^/2  hotn's  of  I'.inet  testing  her  conversation  and  ac- 
tions were  sensible  and  natm^al  thniout,  exce])ting  for  three 
or  four  incorrect  or  peculiar  uses  of  words  and  exce])ting  that 
she  showed  a  m.arked  tendency  to  gossij),  to  over-conhde.  and 
to  talk  rt'/Zi; /'('/;.  There  was  also  some  abnormal  contusion 
of  memories.  "Revolution  is  when  the  man  rang  the  Liberty 
Bell."  It  is  "where  they  make  a  big  racket,  Intt  \  don't  guess 
they  do  either."  "It's  where  the  soldiers  meet  together  to 
tell  over  their  old  times  ami  talk  about  the  revolution." 
"What  I  thought  was  when  that  little  l)oy  called  Mving. 
father,  ring,'  or  was  it  Paul  Revere's  ride?"  She  once  aske<l 
her  teacher  what  the  capital  of  I'hicago  was. 

On  another  occasion  she  tells  me  that  she  wants  "to  be 
some  place  where  T  can  mind  the  Bible,"  and  grows  (|uite  in- 
tense as  she  complains  that  now  she  camiot  "sa_\-  m_\-  i)ra_\-er- 
with  all  my  heart,"  as  formerly.  She  says,  "I  think  its  aw  ful 
that  they  ever  crucitred  Christ  that  way,  don't  you?"  She 
wants  to  be  a  "Catholic  Sister."  tho  not  a  I'atholic  now.  After 
rambling  on  in  gossip  about  the  institution,  she  wants  to  talk 
of  sex  matters,  and  says  she  would  tell  of  the  dirt}'  things  the 
girls  sav.  "if  yoti  were  not  a  man."  She  claims  that  she  will 
not  listen  to  these  things  herself.  .She  showed  distinct  sexual 
excitement  at  various  times  and  in  the  presence  of  other  men. 
She  is  easily  influenced  even  to  mean  conduct,  b}  certain 
girls,  and  her  disposition  and  mentality  are  (|uite  diflerent  on 
different  days. 

Another  of  Beulah's  characteristics  which  she  shares  with 


/S  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

Other  epileptics  is  her  inchnation  to  talk  about  her  ''spasms" 
and  otlier  ailments.  Incidentalh'  her  talks  with  me  about  her 
convulsions  throw  more  or  less  real  lig^ht  on  their  character. 
Some  of  her  convulsions  have  been  recorded  as  epileptic  and 
others  as  hysterical.  As  a  matter  of  fact  some  of  them  evi- 
dently have  both  characters.  Sometimes  she  has  been  "talked 
out"  of  "having-  an  attack"  by  the  assurance  that  she  would 
not  have  it.  Sometimes  she  can  avoid  them  by  telling  the 
girls  to  "come  and  play  with  me."  Sometimes  she  does  not 
lose  consciousness  in  the  attack  and  then  she  feels  so  dread- 
fully that  she  tries  to  reach  the  unconscious  condition  to  es  ■ 
cape  the  torment,  and  thus  may  sometimes  seem  to  "put  it 
on."  She  would  always  rather  "lose  conscience"  than  to 
know  what  is  going  on  in  the  attack.  Ordinarily,  in  a  con- 
vulsion, she  is  only  aware  of  her  head's  initial  turning  to  one 
side.  She  has  been  a  sleep-walker,  and  tells  of  recent  in- 
stances in  which  her  sleep-walking  was  the  expression  of  a 
dreauL  She  is  reported  by  her  teacher  and  others  to  have 
had  attacks  in  which  she  would  become  "nervous"  and 
"faint'"  without  losing  consciousness  or  falling,  and  to  have 
had  other  attacks  that  were  "markedly  hysterical." 

In  tapping  as  fast  as  possible,  in  the  first  30-second  test 
Beulah  pounded  the  key  somewhat  and  was  quite  irregular 
in  rate.  In  the  second  trial  she  hammered  as  if  she  would 
pound  the  instrument  to  pieces,  even  pounding  with  her  el- 
bow, clawing  with  painful  tenseness,  and  growing  red  in 
the  face.  In  the  third  test  it  was  painful  to  watch  her,  the 
movement  was  so  beyond  her  control  that  her  fingers  could 
scarcely  hit  the  key.  In  the  fourth  test  her  movements  were 
"wild,"  and  fearing  a  general  convulsion  the  testing  was  not 
carried  fin"ther. 

In  the  written  tests  l^eulah  shows  man}-  errors  and  a  rather 
variable  performance,  apparently  doing  well  but  for  distrac- 
tion.   Her  story  of  the  trip  in  a  flying-machine,  while  show- 


CI.IXKAI.  STIJDIKS  OF  UdKl  ilk  (ASICS.  79 

iiij^'  iiiia,L;iiiativc'  al)ility,  is  spoiled  l)y  "l;'!'"  iwn  ii])""  iin  iraliziii^'. 
I  Ici"  handwritin,!^"  is  that  of  a  iinicli  Noiin^cr  child  and  she 
omits  niost  nf  the  punctuation  marks,  .'^he  occasionally  mis- 
s])ells,  exam])le>  hi'inj^"  staches  (statue).  roes\-  (ros\-),  hear 
(hair),l)een   (bean),  the  lthey).ti»  (  twi  i  and  too  ). 

Beulah  writes  ver_\'  smooth  l'"n^lish  and  shows  a,  prettx' 
orii^i'inality  of  thought  and  si)ri<;htliness  of  imaj^ination  in 
making  up  little  stories,  one  at  least  of  which  has  heen 
printed  in  a  newspaper.  J  (juote  the  hrst  ])art  of  another,  of 
the  many  that  she  has  written  for  me: 

THE  I.IBKRTV  BELL. 

"I  was  dug  out  (jf  the  ground  all  rust  and  dirt\'.  and  in 
little  tiny  pieces.  1  was  sent  to  a  big  manufacture  and  ])ut 
into  a  very  hot  oven.  ]  stayed  there  so  long"  that  I  went  to 
something  runny  like  water.  .\nd  then  1  was  pounecl  till 
I  thought  there  was  going  to  be  nothing  left  of  me  at  all.  Ihit 
when  they  stopped,  what  do  you  think  1  was?  \Vh\',  1  was 
a  big  bell. 

And  I  was  so  heavv  that  it  took  a  good  man\-  men  to  lift 
me.  They  put  me  in  a  very  dark  car  and  I  had  a  long  ride. 
The  car  stoped  man\-  times.  lUit  no  one  came  to  take  me  out. 
lUit  at  last  four  men  took  me  out  and  ])ut  me  in  a  big  tower 
and  rang  me  many  times. 

One  day  a  very  old  man  came  and  stood  b\-  wc  a  long 
time.  P'retty  soon  I  heard  a  boy  cry,  ring  grandpa,  ring  and 
it  is  said  he  rang  me  so  hard  that  I  cracked." 

Her  ''Storv  of  a  Penn\-,'"  ".Stor\-  of  a  Xeedle,"  and  most  of 
her  other  stories  are  built  on  much  the  srune  simple  tnodel 
siigg'ested  by  her  school  lessons  ;  and  I  fear  that  there  may  be 
even  here  the  ten  lenc^•  to  automatic  woodenness  of  imita- 
tion so  common  in  the  deteriorations  of  epile])sy.  lUit  she 
has  had  little  instruction  or  sNiniiathetic  encouragement  in 


80  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

this  story-writing-,  a  s^ih  which  niight  well  be  utilized  to  the 
advantage  of  the  girl  and  of  the  school. 

The  case  is  one  of  those  sad  ones  in  which  along  witli  a 
streak  of  g^enuine  ability  there  is  mild  but  unmistakable  de- 
fect of  both  intelligence  and  emotions,  with  incipient  psy- 
choses characteristic  of  epileptic  deterioration.  It  woidd  be 
a  fatal  mistake  for  Ueulah  to  attempt  living  at  her  own  di- 
rection outside  of  the  institution.  As  I  write,  the  latest  report 
comes  that  she  "continues  bright  and  original,  but  makes  no 
more  progress  in  school  work." 


CLIMCAI.  STL'Dll'.S  UF  liOKDEK  CASKS. 


Marshall   P..,  .-li^e   Thirfy-si.r   }\^ai's. 


CASE  13.—  Mildly 

Insane, 

while  Feeble- 

Minded 

Semi- 

Delu- 

sions. 

Automat 

isms, 

Grandii 

oquence 

Re- 

ligious 

Mania 

and 

Moraliz 

ing. 

Marshall    i>    one   of    the    ohU'V   "children."    lull    all    of   the 
feeble-minded  remain  hoys  and  i^irls  for  life,      lie  is  a  good 
example  of  an   intermediate  condition  between   feeble-niind- 
edness  and  insanity,  and  is  often 
thouiiht  to  be  too  wise  for  either. 
We  shall  see. 

Of  his  family  it  is  stated  that 
the  mother  died  insane  and  the 
father  of  alcoholism.  Previously 
to  1891  the  boy  was  for  some 
time  in  a  C'athi^lic  school  and  it 
is    commonly    said    that    he    was 

"studying  to  be  a  ])riest."  In  1891  he  was  adjudged  insane 
in  Cook  Co..  Illinois,  and  was  sent  to  a  hospital  for  the  in- 
sane. Two  months  later  he  w^as  sent  to  Lincoln  where  he 
has  since  remained. 

At  present  he  is  a  man  of  average  weight  rmd  2.4  inche- 
below  the  average  height.  His  head  is  22  mms.  l)elow  the 
normal  in  circumference  and  is  shorter  than  the  average  by 
10  mms.  The  forehead  lias  depressions  abcive  the  orbits, 
the  I'aws  are  well  forward,  the  wings  of  the  nose  are  wide, 
the  lips  thick,  the  tongue  over-large,  the  teeth  and  jaw  irreg- 
ular and  the  palate  a  little  high. 

There  occurs  a  ver\'  frequent  and  marked  contraction  of 
the  nmscles  surrounding  and  closing  the  eyes,  with  win.king 
and  drawing  down  of  the  evcbrows.  The  eyeballs  themselves 
are  rolled  by  times  and  show  marked  incoordination,  espe- 
cially when  excited  as  when  i)]a\ing  tlie  horn  in  the  hand. 
The  eyes  will  not  steadil\-  follow  a  luoving  object. 

The  fingers  and  h.ands  .are  large  and  chubbw  tlic  shoulders 
are  held  unequallv.  and  the  bodi!\'  carriage  and  walk  are  un- 
toned  and  stooping.    The  lung  ca])acit\-  is  considerably  above 


82 


BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 


the  normal  average,  while  his  strength  of  grip  is  somewhat 
below.  The  right  eye  has  but  two-thirds  of  normal  vision. 
Hearing  is  normal.  The  physicians  do  not  report  any  serious 
physical  (li>turl)ances  beyond  some  troubles  with  digestion. 
At  a  little  distance  Alarshall's  stooped  and  peculiar  walk 

and  his  decrepit  and  unkempt 
appearance  suggest  a  rapidly 
aging  little  old  man  instead 
of  a  "youth"  of  36.  Seen 
more  nearly  he  will  be  found 
to  be  talking  to  himself  or 
others.  He  will  probably 
have  a  policeman's  club  or 
some  substitute  for  it ;  and 
from  one  to  three  police- 
man's stars,  actual  or  imi- 
tated, will  be  pinned  on  his 
chest  tho  perhaps  partially 
concealed  from  sight.  At  in- 
tervals, and  frequently  when 
absorbed  in  conversation,  he 
makes  a  stereotyped  move- 
ment with  one  hand,  striking 
it  against  his  lower  chest. 
The  movement  is  so  habitual 
as  to  wear  his  shirt  away. 
Questioned  about  it  he  says 
it  is  a  "little  way  of  mine." 
His  garrulity  is  remarkable, 
and  is  marked  by  a  cere- 
monious use  of  gestures  and  i)et  phrases.  Scholastically, 
Marshall  is  reported  to  know  three  or  four  languages  and  to 
give  other  bookish  evidence  of  deserving  a  place  outside.    As 


^rAUSIIALL   E. 


ci.ixiCAi.  sTi^jJii'.s  oi'  i:()1<i)i:k  casks.  83 

a  nialter  of  fart  lie  can  sa_\-  llic  I 'alcr  Xostcr  and  scjiiic  oilier 
church  ])icccs  in  l.alin,  is  really  able  to  converse  somewhat  in 
Cieniian.  and  has  somewhere  ac(|nired  a  very  superficial 
ac(|uaintance  with  a  little  French.  I  le  exploits  these  furbelows 
to  the  dismay  of  the  uninitiated,  and  (|uotes  dates  with  an  air 
of  exactness  that  tends  to  conceal  their  frecjuent  inaccuracw 
He  rehashes  stock  nioralizini^s  in  <;randilo(|uent  lan,<;"na,ye  and 
st}'le,  and  with  much  i)unniii^-  and  iokin<;. 

Brought  to  task  with  numbers,  however,  he  is  utterl\-  un- 
able to  multii)ly  or  di\-i(le  b_\'  two  digits,  and  shows  general 
confusion  in  handling  numbers;  when  asked  to  divide  he  did 
the  sum  by  adding,  and  incorrectly  at  that.  ;\sked  liow^ 
many  apples  at  3c  each  he  could  buy  ^\■itll  45c,  he  fumbles, 
counts  on  his  fingers,  and  says:  "I'd  get  45  apples  at  3c  a 
piece  and  I'd  lie  left  8qc  total."  His  handwriting  is  verv 
scrawled,  irregular,  and  angular,  but  is  more  legible  than 
it  appears.  He  is  punctilious  with  his  s]:ielling,  the  500  words 
written  in  three  tests  showing  no  real  mis-spellings  except 
that  of  pedestal,  tho  he  occasionally  neglects  to  write  some 
letter.  He  can  read  the  local  paper  with  ease  1)ut  d(x\s  not 
do  very  much  reading.  His  articulation  shows  a  recurring 
difftculty  in  sounding  "th",  and  there  is  a  thickness  of  sjieech 
as  of  a  person  semi-intoxicated. 

In  the  band  Marshall  plays  the  T.  I'.b  bass  horn,  lie  is  a 
poor  reader  but  very  musical.  He  will  learn  to  play  o]:)eratic 
selections  in  a  few  rehearsals,  l)ut  reads  and  ]~)lays  very  auto- 
matically. For  instance,  he  cannot  start  to  play  an \- where 
except  at  the  beginning  of  a  strain. 

The  mental  examination  finds  ^larshall  to  have  but  11 
years  of  mental  age.  He  showed  a  frail  memory  sjian  for 
numerals  and  sentences,  and  embellished  his  account  of  the 
memory  passage  with  masses  of  incorrect  data  stated  in 
"pretty  big  words  but  then  there's  a  meaning,"  as  he  ob- 
served. 


84  BACKWARD    AND    FEEBLE-MINDED    CHILDREN. 

In  the  written  tests  he  reproduced  stories  quite  well,  but 
no  test  shows  any  productive  imagination.  He  crossed 
A's  rapidly  but  with  irregular  accuracy,  and  was  able  to 
write  similars  and  opposites  for  most  of  the  test  words  given. 
One  hundred  association  tests  gave  but  12  normal  single 
word  reactions,  86  being  sentences  or  phrases  used  to  define. 
The  stinuilus  word  was  repeated  13  times.  In  twelve  reac- 
tions he  made  a  gesture  as  his  first  or  a  prominent  part  of  his 
first  response  to  the  stimulus.  His  definitions  are  often  ex- 
cellent but  for  their  wordy  and  ceremonious  form.  His  tend- 
ency to  automatism  appears  in  his  adherence  to  a  fixed 
tempo  adopted  for  these  reactions,  37  of  the  100  reactions 
being  within  one-fifth  second  of  his  quick  median  time  of 
1.7  seconds.  He  used  this  same  tempo  on  another  occasion 
when  reacting  with  the  similars  of  given  words. 

Marshall  is  reputed  to  be  honest  and  generally  trustwor- 
thy. He  gets  on  well  with  the  boys,  helps  with  odd  jobs,  and 
spends  much  time  with  his  music.  He  delights  in  having 
children  about  him  and  they  are  fond  of  him.  He  is  a  de- 
voted Catholic,  talking  much  of  religion  and  attending  as 
many  church  services  and  funerals  as  possible.  He  has  occa- 
sionallv  shown  mild  delusions  of  persecution,  these  even  be- 
coming "pronounced"  at  one  time.  He  only  half  believes 
that  he  is  a  policeman,  but  he  persists  in  acting  the  part. 
A\'hen  excited  in  reading  or  talking  he  "lays  it  off"  in  ges- 
tures, rolling  his  eyes  and  contracting  his  facial  muscles. 

Marshall's  speech  and  writing  abound  in  high-sounding 
but  hollow  strings  of  words,  ceremonious  statements,  stock- 
expressions,  and  examples  of  mental  automatism  and  stereo- 
typy that  are  of  a  kind  with  his  formal  and  incessant  gestur- 
ing and  his  automatic  movements.  Some  of  this  is  illustrated 
in  the  following  extracts  from  one  of  his  letters.    "I've  got 


CI.IXICAL  STUDIES  OF  lU)Kr)KR  CASRS.  85 

no  show  ])ush  ]hi11  l)ackin<4-  nor  slaixlini^"  ''■''  ''■'  I'm  a  poor 
homeless  rehitionless.  deslilute  lad  '•'  '■''  I'm  for  all  and  I'm 
not  Pretentious  Pernicious  Su])er>litious  l)ecei)live  nor  of 
the  dislikin<;-  kind  of  People.  I'm  not  huilt  that  way  I'm  like 
the  Hon  Hem-}-  (ieort^e  and  lii>  ^real  5  ct  eii;ar.  he  sax  s  he 
and  his  cigars  are  l)olh  for  man  but  the  chief  one  is  Jesus 
Christ  mine  and  _\-our  Savor  so  there  you  are  althouj;h  Pm 
a  sinner  I  declare  to  goodness  I  look  things  s(|uare  right 
justly  and  Honestly  in  the  face  as  so  should  he  ma_\'  he  and 
must  be  the  case." 

He  is  another  classic  example  of  llighty  attention.  Too 
many  things  occur  to  be  said,  directive  control  is  lacking, 
and  the  normal  sec[uences  are  broken.  In  writing  he  con- 
stantly slii)S  from  his  point  and  starts  with  some  unrelated 
topic  that  has  caught  his  attention.  His  frail  menial  s])an 
fails  to  hold  what  is  just  past  until  it  may  exercise  its  blend- 
ing control  upon  what  is  coming.  If  some  one  brings  him 
back  to  the  circumstances  his  intelligence  usuall)'  suffices  to 
meet  the  situati(Mi.  Asked  to  compare  two  given  words  he 
finds  it  impossible  to  hold  them  apart  and  examine  eacii 
singly.  As  he  writes,  some  of  the  letters  and  words  intended 
drop  out  of  the  functioning  mental  span  before  they  can  l)e 
written,  and  thoughts  as  (juickly  leave  his  mind  as  he  talks, 
so  that  some  of  his  sequences  are  as  bizarre  as  those  of  cer- 
tain dementia  pnecox  cases.  Put  except  f(^r  this  weakness 
of  mental  span  his  thought  seems  to  go  forward  with  a  fair 
sort  of  logical  sequence.  He  falls  back  on  a  domination  by 
sound-sequences  and  symbolism,  rounding  out  and  expand- 
ing his  adjectives  and  phrases  in  tiresome  prolixity  and  tau- 
tology. 

All  this  is  of  course  more  symptomatic  of  insanity  than  of 
feeble-mindedness.     But  there  are  as  well  the  evident  stig- 


86  BACKWARD   AND  FEElJLE-MINDED  CHILDREN. 

niata  of  defective  growtli  in  body  and  in  mind.  A  nature 
badly  formed  would  seem  to  have  nevertheless  pushed  on  to 
a  further  stage  of  intelligence  than  is  commonly  reached  even 
Iw  the  high-grade  feeble-minded,  but  only  to  be  thrown  back 
in  some  of  the  deteriorations  that  so  often  mark  dementia 
prsecox.  It  is  unfortunate  that  we  do  not  yet  have  a  history 
of  Marshall's  earlv  adolescence. 


cr.TNlcAL  .sji:i)iF,s  oi-  i;oki)i;k  casks. 


87 


Corbiii  C,  .-Iq-r  lliirtccii  Years. 


CASE  14. — Menin- 
gitic  Feeble-Minded- 
ness.  Violence  to 
Playmates,  Confused 
Substitutions  for 
Acts  Intended.  Ex- 
citable and   Noisy. 


Corbin  C.   is  a   nallimore  boy   wlioni   I   examined  at   ibe 
Jolins  Hopkins  llos])itaL     He  is  t\])ical  of  a  class  of  cases, 
nunil)ering'  one-eiglitb  of  a  wear's  admissions  at  Lincobi.  who 
are  usually  reported  t(^  have  had 
menini^itis  or  "brain  fever,"  most 
often  in  infancy. 

C(jrbin's  family  seem  normal, 
except  that  a  yount^er  brother  is 
a  deaf-mute,  a  condition  said  to 
be  sequent  to  a  severe  burn  of 
three  years  as2,o,  but  probably  of 
more  fundamental  ori,Qin.     Cor- 

bin's  birth  was  normal,  and  up  to  the  age  of  fifteen  months 
he  is  reported  to  have  developed  normally,  learning  to  walk' 
and  making-  progress  with  talking-,  etc.  At  that  age  he  is 
said  lo  have  had  a  severe  fall,  striking  upon  his  forehead. 
A  few  weeks  later  he  sulfered  a  severe  attack  of  meningitis 
and  is  said  to  have  had  spasms.  After  this  he  never  acted 
like  other  children,  and  did  not  re-learn  talking  or  walking- 
until  three  and  a  half  years  subsecjuentlv.  He  always  acted 
"wild."  would  yell  loudly  as  if  "hysterical,"  indulged  in  all 
sorts  of  n-iischief  and  was  extremely  destructive,  breaking- 
dolls,  tearing  clothes,  etc.  He  is  said  to  be  fond  of  ])laying 
"Indian."  His  mother  "claims  that  he  is  absolutely  l)eyond 
correction. 

Corbin  attended  school  four  years,  beginning  with  his 
sixth  year.  He  never  advanced  beyond  the  lowest  grade,  and 
for  the  past  two  years  his  mother  has  kept  him  awa_\'  from 
school.  He  would  not  return  from  schoijl  until  late  in  the 
evening,  and  would  wander  away  from  home.  At  night  he 
sleej^s   l)ut   little   and   then   has    somnambulisms,    wandering 


88 


BACKWARD   AND   i-'EEBLE- MINDED   CHILDREN. 


about  tile  house  in  api:)arent  fright  and  talking-  constantly, 
sometimes  jumping  upon  chairs. 

He  has  lits  of  unprovoked  anger,  and  if  other  children  do 
not  do  as  he  wishes  he  threatens  them  with  any  available 
weapon.  A  week  before  examination  he  struck  a  playmate 
with  a  hammer,  and  he  once  stabbed  his  brother  in  the  fore- 
head with  a  bread-knife, 
tho  sorrowful  about  it  after- 
ward. He  is  extremely  nerv- 
ous and  is  constantly  at  va- 
riance with  other  children. 
(  )n  visiting  the  family  re- 
cenllv  tlie  mother  told  me 
she  had  to  constantly 
"watch  liim  if  he  had  a 
l^nife."  He  is  unable  to 
dress  himself  or  to  tie  a 
"bow-knot". 

The  ph}sical  examination 
records  nothing  especially 
abnormal  except  slight 
exophthalmos,  some  anae- 
mia, and  mouth-breathing, 
lie  is  below  the  norma] 
weight  and  height  but  data 
for  a  full  physical  descrip- 
tion are  not  at  hand.  He  is 
markedly  defective  in  facial 
expression,  with  twitchings 
and  asvmmetrical  contractions  of  the  facial  muscles. 
The  mental  examination  finds  Corbin  to  have  a  mental  age 
of  7^  years  with  5^/2  years  of  retardation.  He  was  unable 
to  distinguish  right  and  left  or  forenoon  from  afternoon. 
There  were  4  fingers  in  each  hand  but  only  5  in  all.     He 


COItBIN  ( 


CI-INKAI.   STUDIES  OF    IU)U1)1-:k   CASES.  89 

could  iiiii  r(.'i)(.';il  ti\c  nuiiu'rals,  confused  5  and  lo-cenl  ])ieces. 
could  not  "clian.i;c"'  4  cents  from  2^  ccnt'^.  and  was  unal)le  to 
count  I)  cents'  worth  of  stamps  or  l)ack\vards  from  20  to  o. 
He  could  not  name  in  order  the  days  of  the  week  or  months 
of  the  year,  nor  ^ive  the  date  even  ai)])roximately. 

Corbin  copied  written  matter,  tho  badly.  Hut  when  asked 
to  write  "The  ])retty  little  girls"  he  wrote  'Sais.'"  appai"entl_\' 
su])posing"  that  this  was  correct,  .\sked  to  write  various 
single  letters  and  ntnnerals  he  would  write  something  en- 
tirely other  than  what  was  called  for.  tho  seeming  anxiotis  to 
do  as  directed,  lie  could  not  read  a  first  reader  selection  con- 
tinuously, l)ut  would  make  out  some  words  and  then  jump  at 
wrong  conclusions  about  the  others.  Tie  tended  to  become 
excited  and  woidd  then  say  bizarre  things.  Confused  in  try- 
ing to  name  nickels  and  dimes,  he  commenced  to  say  "live 
cents,  ten  cents,  fifteen  cents,"  becoming  more  excited  and 
wanting  to  write  these  words  at  the  lilackboard.  In  trying 
to  count  the  value  of  stamps  he  talked  conftisedly  of  getting 
"two  for  a  cent,  and  red  ones  you  get  three  for  a  cent."  The 
days  of  the  week  were  "Sunday,  Monday,  Palm  .Sunday,  it's 
tw^o  Sundays  before,"  etc.  When  he  could  l)e  kc/^f  calm  he 
talked  readily,  descril)ing  pictures  ])romptly  and  with  some 
fullness,  carrying  out  commissions,  etc. 

W'e  have  here  a  child  whose  permanently  injured  brain 
makes  him  extremely  liable  to  states  of  uncontrolled  excite- 
ment, these  states  being  attended  bv  conditions  of  anger,  fear, 
anxiety,  with  aphasia  and  apraxia,  according  to  circum- 
stances. The  bizarre  responses,  the  paraphasia  and  para- 
kinesia that  occur  so  frequently  in  the  testing  of  these  cases, 
are  probably  of  a  kind  with  the  hammering  and  cutting  of 
playmates;  and  this  characteristic  of  their  mental  function- 
ings  causes  some  of  them  to  be  very  dangerous  members  of 
society.  Still  others,  while  harmless,  Ijreak  out  with  ill-timed 
fits  of  laughter,  with  jumping,  veiling,  or  what  not,  misunder- 


90  BACKWARD  AND   FEEnLE-MlNDED  CHILDREN. 

stand  directions,  etc.  One  little  girl  persisted  in  trying  to 
put  the  window  ///>,  in  her  earnest  attempt  to  carry  out  my 
request  and  my  obvious  endeavor  to  put  it  doivn.  Many  of 
these  children  are  deficient  in  facial  expression  or  in  its  nor- 
mal control,  while  many  others  look  far  more  intelligent 
than  they  are,  the  features  not  having  been  marred  by  pri- 
mary degenerative  tendencies  in  growth.  As  a  rule  it  is  ex- 
tremely difficult  for  these  children  to  profit  by  the  normal 
or  usual  methods  of  learning.  In  the  case  of  Corbin  the  child 
will  certainly  escape  much  trouble  by  being  placed  in  a  good 
institution,  and  society  will  be  the  safer  for  it. 


CLiMCAi.  siri)ii:s  oi'  hokdi-.r  casks. 


91 


CASE  15.- 

-A 

phasia 

with  Defective 

Facial 

Expression. 

Enure- 

sis.  Good  Int 

sll 

igence 

shown    in    N 

0 

r  m  a  1 

Play. 

JJarold  Jy..  .li^c  Si.v  Vcars. 

The  two  following;"  cases  from  the  year's  a(hnissions  at  Lin- 
cohi  arc  prol)ably  to  he  classed  witli  the  ])rece(hnii'  case  as 

ilhistratiii^'  tlie  varied,  eti'ects  thai  l)rain  lesi'.Mis  nia}'  have  in 

children   lliat   are  ])rin,iari]\-   well 

endowed. 

Harold  R.,  a  sol)er-faced  little 
hoy  estimated  to  he  of  the  age  of 
six,  droi)i)ed  in  from  nowhere 
one  jnly  day  in  1910,  and  noth- 
ing has  1)een  learned  of  his  fam- 
ily    or     personal     history.     The 

hoy's  weight  was  ^^2  pounds  and  hi^  height  was  37>j  inches. 
Mis  walk  was  normal  hut  his  si)eeeh  was  limited  to  a  few- 
words  imi)erfecll_\-  uttered,  and  his  hearing  seemed  to  he 
(|uite  defective  on  either  side.  His  vision  seemed  to  he  of 
fair  acuitv  in  spite  of  severe  strabismus.  .\t  least  it  enal)led 
him  to  tie  threatls  and  to  deal  with  small  objects,  lie  was 
found  to  be  troubled  with  enuresis.  The  medical  examina- 
tion fomid  no  additional  abnormalities  1)iU  classedi  him  as 
an  "idiot,"  and  to  everyday  o1)servation  he  hardly  gave 
pr(_imise  of  more  than  this. 

Tried  with  the  r>inet  tests  the  boy's  inability  to  talk  pre- 
vented his  going  mucli  ftu-ther  than  the  tests  for  two  year< 
of  mental  age.  As  usual  in  such  cases  I  iiu|)rovised  some 
tests  with  objects  such  as  would  tend  to  call  forth  the  higher 
levels  of  reaction  if  there  might  be  any.  I  I  ere  i^-^  what  hap- 
pened with  this  mii)romising-looking  "idiot":  ( iiven  my 
bunch  of  keys  he  went  to  the  laboratory  door  and  tried  in 
its  lock  only  the  key  whose  size  set'mcd  to  pnunisi-  a  fit. 
lie  tried  the  latch  too,  tinkering  with  the  more  i)roniising 
parts,  h'inall}-  he  tinned  the  knob  of  the  upi)er  lock  and 
//('/(/  //  so  till  he  coidd   sinndtaneousl_\-  tm-n  the  lower  knob, 


92 


BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 


and  thus  ()])en  the  door.  He  very  evidently  foresaw  the  ne- 
ces>it\-  of  operating"  both  locks  simultaneously,  as  was 
proved  by  his  repeating  tliis  coml^ncd  procedure  until  he 
could  get  it  to  work.  Having  been  told  that  he  could  get 
out  he  worked  at  this  task  for  a  long  time,  hesitating  only 

with  an  occasional 
"tan't." 

Ciiven  a  box  of 
blocks  he  sat  mo- 
tionless before 
them  for  ten  min- 
utes, probably 
thinking"  that  I 
meant  them  to  be 
let  alone.  Assured 
then  that  he  might 
play  with  them,  he 
immediately  took 
them  out  one  by 
one  /'/:  order  of  she 
and  arranged  them 
in  a  long  row  from 
smallest  to  largest. 
He  expressed  his 
enjoyment  of  this, 
and  called  my  at- 
tention to  his 
"finds"  of  various 
kinds  of  blocks.  He 
searched  continu- 
ously till  he  found  all  the  cones  that  would  lit  the  holes  in 
certain  blocks.  The  T-square  was  next  rested  on  three 
four-legged  blocks  to  form  a  trestle,  and  he  varied  the  dis- 
tances between  the  trestle's  supports,  with  much  enjoyment. 


HAROLD  R.  AND  MORTON  W. 


ci.iNiCAr.  s'rrini-:s  of  hordi-.r  casks.  93 

Tn  such  \\a\s  Iil'  I'lawd  on  1)_\  the  Imur.  unaiilcd  and  \vith- 
ont  disturhin^-  nic,  Iiuniniinii'  a  sort  of  mclod}'  tor  awhile 
l)ut  usually  (|uict. 

I  showed  him  the  form  hoard  and  i)laced  each  hlock  in 
its  place.  When  the\-  were  removed  he  prompll}-  accei)ted 
the  ])rol)lem  and  ])laced  each  hlock  in  some  place.  l)ul  at 
random,  ddicn  for  four  trials  I  called  his  mis-placements 
wron.c;  and  placed  them  ri^ht.  In  the  fifth  he  succeeded  in 
221  seconds,  heli)ed  In-  one  hint.  Next  time  his  time  was 
130  seconds,  unaided.  The  next  was  nnich  (juicker  hut  lor 
an  accident.  He  did  the  next  in  5S  seconds,  and  crowed 
with  delii^ht.  lie  would  never  allow  that  it  was  "done"  til! 
every  piece  was  proi)erl\-  in  iilace. 

A\'hen  shown  the  card-sorting  tray  with  50  scfuare  cards 
in  its  central  com]iartmcnt,  he  at  oucv  joined  with  me  in 
turning  over  each  to  see  its  color  hefore  ]>lacing  it  in  the 
proper  compartment  for  this  color.  Xext  lime  he  did  it  un- 
aided, sorting  all  to  the  five  trays  without  an  error,  in  (d^ 
minutes.     He  enjoyed  it  thoroly. 

These  and  other  tests  and  further  ohservation  ot  his  ])lays 
showed  that  he  had  normal  spontaneity  and  the  ahility  to 
learn  progressivelv  from  his  experiences.  His  i)ower  of 
will  and  attention,  as  shown  in  i)ersistent  tho  not  automatic 
application  to  the  task  in  hand,  are  even  ahove  thai  usuall\' 
found  in  a  6-year-ol(l.  liis  use  of  make-helieve  and  his  imi- 
tative acting  out  of  past  ex])eriences,  and  the  inlelligence  w  ith 
which  he  chose  his  ends  and  means  and  ada])te(l  these  to 
each  other,  w'ould  also  hr  creditahle  to  most  hoxs  ol  (>. 

We  evidently  have  here  an  aphasic  child  who  hut  lor  the 
disturhance  of  hearing  and  of  s])eech.  of  mimic,  and  ])crhaps 
of  still  other  of  the  normal  means  of  expression,  would  l)e 
able  to  do  the  mental  work  normal  to  his  age.     It  will  be  in- 


94  iJACK\\AKD   AND   l-EKBLE-MlXDliD  CJIILDKEN. 

teresting  at  some  later  time  to  record  the  result  of  a  sys- 
tematic examination  for  aphasia,  which  I  hope  may  be  car- 
ried out  later.  The  psychologist  now  resident  at  Lincoln 
writes  me  that  this  is  "the  only  child  who  has  asked  me 
'why'  instead  of  trying  to  do  what  I  asked." 


CLlNlCAr.   STlUMi:.S  Ol'-    IWJKUliK  CASliS. 


95 


Alorlon  Jl\,  /li^e  Seven  Years. 


CASE 

16. — Menin- 

gitis   and 

Other    Dis- 

eases     in 

1  n  f  a  n  cy. 

Aphasia, 

with  Defect- 

ive      Fac 

al      Expres- 

sion   and 

Motor  Con- 

trol.       Good      Intelli-      | 

gence  an 

d  Volition. 

Morton,   like    I  larold.    looked    uiiproniisini;-   cnoiiL;h    when 
admitted  in  that  same  July,     liul  "brains  will  tell."     And  the 
natural    ])lay    and    work    x  k  m    ri'vealed    1)\-    ihe>e    two   little 
boys    refreshingly    reminded    us 
that  there   were   levels  of  baby- 
land    whieh    the    institution    was 
sadly  used  to  beini^  without. 

Morton  had  lost  his  father  and 
mother,  the  former  d\ing  of  he- 
patic abscess,  the  latter  of  loco- 
motor ataxia.  There  was  defect- 
ive hearino-  in  the  father's  fam- 
ily.    One  child  was  stillborn  and 

another  died  at  8  months.  Dm-ini;-  the  jieriod  before  .Morton's 
birth  the  mother  was  malarial  and  mentally  troubled.  There 
was  difficult  labor,  and  the  child  had  severe  icterus  for  tliree 
months  with  no  "ain  in  weight.  Some  da\s  after  birth  he 
went  into  a  condition  in  which  his  head  was  retracted  an<l 
he  had  slight  spasms.  It  has  been  supposed  that  he  had 
meningitis.  At  i6  months  he  had  measles  followed  by 
chorea.  At  3^^/  years  he  had  scarlet  fever  followed  bv  lefl 
otitis  media.  There  was  some  left  i)aralysis  in  infancy,  and 
the  child  stood  first  at  28  months  and  walked  at  three  \ears. 
He  was  described  as  industrious,  cheerful,  neat,  ill-tempered, 
and  excitable,  and  had  not  been  to  school. 

I'hysically  Morton  weighs  45  Ij  ])ounds  and  is  45^2  inches 
in  height,  with  large  and  well  formed  head,  fair  vision, 
and  hearing  that  is  (|uite  defective  as  orJiimrily  iiicasiircJ. 
Some  but  1  think  not  all  of  the  hearing  defect  seems  to  l)e 
due  to  "mental  deafness."  His  walk  is  defective  and  his 
speech  is  even  more  so.  tho  he  talks  somewhat  and  mider- 
stands  what  is  said,  but  with  difficulty.     His  facial  exprcs- 


96  By\CKWARD   AND  FEEBLE-MINDED  CHILDREN. 

sion  is  largely  wanting  and  is  apt  to  be  abnormal  when  it  oc- 
curs, and  the  carriage  of  the  head  is  abnormal.  No  medical 
record  is  obtainable. 

Morton's  difficulty  \vith  language  rendered  impossible  an}.' 
rating  with  the  Hinet  scale.  As  in  the  case  of  Harold  we  fell 
back  on  ol'servation  of  the  child's  I'lay,  his  manipulation  of 
tools  and  other  objects,  and  his  readiness  to  meet  various 
objective  situations  not  involving  speech  :  Turned  loose  to 
play  in  the  laboratory  he  quickly  showed  the  spontaneous  ac- 
tivities of  which  his  brain  was  capable.  Spools,  rubber  rings, 
blocks,  the  T-square,  etc.,  were  promptly  utilized  in  the  con- 
struction of  a  railroad  and  trains.  A  derrick  was  rigged  up. 
with  pulleys.  Ide  foraged  in  drawers  and  cupboards  and 
boxes  for  the  necessary  strings,  lilocks,  and  other  pieces, 
and  formed  definite  plans  of  construction  which  he  persisted 
in  carrying  out,  intelligently  choosing  and  adapting  resources 
to  the  realization  of  these  plans. 

To  illustrate  his  conduct  in  the  face  of  difficulty:  He 
opened  a  heavy  drawer  full  of  sundries,  to  find  playthings, 
but  was  told  to  close  it.  Demurring  slightly,  he  then  tried 
several  times  but  the  drawer  caught  at  the  sides  and  he 
called  my  attention  to  this  fact.  I  insisted  and  he  then 
pushed  alternately  at  either  end,  moving  it  thus  each  time 
the  very  little  distance  that  it  would  go.  Again  he  called  my 
attention  to  the  unpleasant  difficulty  ;  but  seeing  now  that  I 
;;;//.s7  have  it  closed,  he  tugged  away  with  at  least  fifteen 
pushes  regularly  alternating  at  either  end,  and  with  a  good 
many  at  the  middle  which  helped  a  little,  till  half-inch  by 
half-inch  the  drawer  was  completely  closed,  tho  not  easing 
up  at  any  time.  He  had  to  imsh  with  all  his  might  to  budge 
it  at  all,  and  there  was  nothing  apparent  to  make  this  any- 
thing but  the  very  disagreeable  and  uninteresting  task  that 
we  usually  find  it.    Yet  he  showed  no  emotion  or  sign  of  im- 


CLINICAL  STUDlIvS  OK   I'.OKDKR  C.\.S1-:S.  OfJ 

patience,  nor  did  he  even  look  aroinid  ftjr  commendation 
when  he  was  at  hist  successful 

Asked  to  l)utton  the  eleven  huttons  of  a  loni;-  testinj:^  strij) 
of  cloth,  his  motor  coordination  was  seen  to  he  jioor  and  at 
first  he  failed  on  the  first  hutton  and  demurred,  savin;;- 
"Hard."  Then  he  lahoriously  did  this  one;  and  then  one  hy 
one  he  laljored  with  the  others  till  all  were  done,  den'.urrin,^' 
hut  three  times  and  saying-  'M  lard"  a  time  or  two.  1  le  showed 
that  he  thoroly  disliked  the  joh,  as  it  was  very  difficult  iox 
him  and  occupied  7  minutes  and  40  seconds.  lUit  there  was 
no  whining  or  show  of  emotion,  and  he  worked  on  steadily. 
At  the  end  he  seemed  satisfied,  but  without  emotion,  not 
even  smiling.  He  made  a  gradual  reduction  of  the  time  per 
hutton  thruout  the  test.  In  the  test  for  threading  needles, 
after  much  difficulty  resolutely  faced  he  finally  succeeded  by 
cliaiii^iii':;  ends  of  the  thread,  with  evident  intention. 

Morton  showed  uniform  good  nature  thruout  all  the  hours 
of  our  testing.  Even  \\'hen  urged  to  do  difficult  tasks  that  he 
disliked  he  never  showed  anger  or  whining.  He  would  very 
briefly  demur  and  would  then  attempt  the  task.  Tho  rarely 
smiling,  his  busy,  unruffled  way  of  meeting  difiiculties  indi- 
cates a  cheery  attitude  of  content  with  people  and  with 
things.  He  enjoys  a  little  teasing,  and  his  laugh  at  a  joke 
w^as  hearty  and  apropos.  His  laugh,  while  almost  uproar- 
ious in  its  heartiness,  shows  some  abnormality  of  sound  and 
of  nervous  control,  and  its  facial  expression  is  gross  in  char- 
acter and  not  sensitively  varied.  I  have  not  seen  him  smile 
in  response  to  the  smile  of  another,  .or  mimic  any  facial 
expression  of  others.  Nor  have  I  seen  his  face  show  ap- 
preciation of  other's  approval,  even  when  success  h.ad 
crowned  struggles  that  were  really  heroic. 

Here  again  we  have  a  case  of  aphasia,  showing  difiiculty 
of  auditory  appreciation  along  with  difficulty  of  speech, 
mimic,  and  emotional   expression,   and   with   some   general 


9(S  BACKWARD   AND   Fi^KIJLE-M  INDED  CIIILUKEX. 

motor  incoordination.  But  tlie  evident  retardation  of  these 
functions  has  left  essentially  intact  the  intelligence,  the  will 
as  persistent  attention  and  application  to  the  task  in  hand, 
and  mental  spontaneity  and  liveliness,  with  a  normal  utiliza- 
tion of  the  experiences  of  past  and  present.  Morton's  diffi- 
culty is  a  matter  of  the  means  of  communication  with  his  nor- 
mal fellows  and  teachers  ;  and  unless  given  very  si)ecial  and 
most  intelligent  attention  he  will  remain  comparatively  unde- 
velojied  and  with  certain  inevitable  perversions,  just  as  oc- 
curs with  neglected  sense  defectives. 


CLixiCAi.  sii;i)ii-:s  of  i;()K|)i:k  c.\si-:.s. 


99 


I'ntiiciiCi'  S..  ./'-('  lilcien  diul  Onc-lnilf   )'ciii-s. 


CASE  17.— Insan- 
ity and  Feeble-Mind- 
edness  in  the  Family. 
Convulsions  before 
Admission.  Intelli- 
gence Normal  when 
Conditions  are  Fa- 
vorable. Frail  Body 
and  Defective  Vision. 


Tlu-  iiistiliuiiin  cmitaiiis   a   wry    \v\\   cluluwu   wlid  arc  d' 
ai)])rMxiinaleI_\-    normal    iiUclliL^ciKw    and    wiio    arc    here    in 
^onie  cases  l)ccause  an  iinpr(i])t'r  cn\ironincnl  lia>  ])rc\-cntcil 
their  having'  ]iro]ier  care  and  de- 
\-clo])nient.  in  other  cases  l)ccansc 
physical  or  sensory  defects  have 
caused  them  to  need  institutional 
care.    A  ty])ical  case  is  I'rudence 
S.,  sister  of  Polly  A.  already  de- 
scribed.    The   reader   will   recall 
the  faiuily  histor\'  of  insanity,  in- 
temperance,   and    feeble-minded- 
ness.   Prudence  was  admitted  two 
years  ago.     It  is  stated  that  she 
did  not  talk  until  3  years  of  age 

and  that  she  had  convulsions  until  near  tlie  time  of  adtuissiou. 
."^lie  lias  had  none  since. 

Physically  she  is  about  7'_>  i)oimds  a])ove  weight  and  i,\2 
inches  above  in  height,  with  a  nonual  cranial  circumference, 
almost  normal  lung  capacitw  and  a.bove  the  average  strength 
of  grip.  Pier  hearing  is  normal  but  she  has  l)ut  one-fift!i 
vision  in  either  eve,  with  strabismus,  ller  ears  are  ai)nor- 
mally  sha])e(l  and  jjroject  markedl\\  the  ])alatal  arch  is 
rather  high,  the  skin  is  ])ale,  chest  is  narrow,  and  the  hands 
show  irregularities  of  nervous  control.  The  girl  is  i>h\>i- 
cally  frail,  needing"  medical  attention  for  various  slight  ail- 
ments, yet  usually  able  to  attend  school. 

In  school  Prudence  is  a  model  ])ui)il,  alwavs  sensible,  over- 
serious,  rather  "old-maidish"  in  her  tendenc\-  to  correct  and 
mother  others,  and  over-scrupidous  and  finical  in  the  ])er- 
formance  of  tasks.     .She  reads  the  third  reader  with  expres- 


lOO  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

sion  and  understanding-,  does  simple  problems  in  division  bur 
is  not  strong  in  number  work,  excels  in  spelling,  drawing, 
manual  and  calisthenics  work  and  in  dancing.  She  makes 
good  progress  with  piano  lessons,  but  her  aggravated  myopia 
interferes  with  this  as  with  other  school  work. 

Mentally  the  Binet  examination  credits  her  with  an  intel- 
ligence normal  to  her  years.  She  gave  persistent  and  pa- 
tient attention  to  the  various  tasks,  and  when  circumstances 
remained  very  favorable  her  reactions  in  the  tests  were  nor- 
mal. There  is,  however,  a  latent  instability  with  peculiarly 
strong  tendency  to  confusion.  For  instance,  in  trying  to  re- 
produce a  simple  news  item  she  made  absurd  errors,  and  also 
in  trying  to  count  by  twos  beyond  a  certain  point. 

The  written  tests  show  a  normally  legible  handwriting. 
Capitals  and  punctuation  marks  rarely  occur  correctly  or  at 
all.  She  spells  twiil  (twelve),  were  (where),  lik  (like),  flor 
(floor),  contry  (country),  wish  (which),  brige  (bridge), 
wile  (while),  oppen  (open),  and  makes  7  or  8  other  more 
usual  mis-spellings  in  the  three  story  tests.  Her  story  repro- 
ductions give  a  fluent,  connected  story,  much  simplified  but 
always  progressing  naturally.  The  total  output  is  not  large 
and  the  imagination  shown  is  rather  meager.  She  gives  such 
"opposites"  as  tall-little,  happy-mad,  false-flys,  like-love, 
glad-happy,  thin-narrow,  war-new,  many-lots,  above-down, 
friend-chum.  Her  weak  showing  in  the  A-test  may  be  due 
in  part  to  poor  vision. 

The  tapping  test  revealed  a  peculiar  weakness  in  the  con- 
trol of  the  left  hand,  a  weakness  not  shown  by  the  dynamo- 
meter. At  first  she  was  quite  unable  to  tap  at  all  with  the 
left,  and  this  hand  had  to  have  many  times  more  preliminary 
practice  than  the  right  to  reach  a  representative  performance. 
When  obtained  the  ratios  to  the  normal  were  149/169  with 
the  right  and  90/139  with  the  left.  These  experiments  need 
to  be  repeated,  as  such  a  local  weakening,  whether  temporary 


CLINICAL  STUDIES  OF  r.ORDF.K  CAS1-:S.  lOI 

or  permanent,  is  sij^iiilicant  especiall}'  in  one   who  has   had 
convulsions. 

General  observation  in  the  institution  finds  Prudence  to  1)e 
steady,  stable,  and  intelligent  ichcit  fliiiii^s  i^o  tvcU,  l)ut  lend- 
ing' to  "go  to  pieces"  when  circumstances  become  difficult  or 
unusual,  as  on  the  occurrence  of  minor  accidents.  I  ler  I'hys- 
ical  frailness  is  ])aral!c]ed  by  a  latent  l)Ut  real  mental  wi'ak- 
ness  which  onh-  a  kiiidl\-  and  fa\'orablc  cn\'ironment  can  jjre- 
vent  from  develoi)ing.  Ideally.  I'rudence  should  be  si)ared 
the  "stigma"  of  life  in  an  institution  for  the  feeble-minded. 
Actually,  she  \vill  fare  best  in  the  institution  unless  she  can 
be  furnished  a  permanent  home  which  w  ill  shieM  her  from 
the  stress  of  guiding  her  own  fortune? 


CASE  18.— Tuber- 
culous Family.  Frail 
Physique.  Weak 
Mental  Span.  Intelli- 
gence Normal  to  a 
Simple  Environment. 


I02  BACKWARD    AND   FEEBLE-MINDED   CIIILDREX. 

/■/('/(/  //.,  J^i^c'  T-7^'ciily-tIircc-  (iiid  Oiic-luilf  ]'cars. 

Somewhat  similar  t(j  the  last  is  the  case  of  \iola  11.,  a 
frail,  diminutive  young  woman  who  has  been  in  the  institu- 
tion for  7,^2  years.     Her  father  and  father's  parents  are  all 

dead  of  tuberculosis.  Her  only 
brother  died  in  infancy  and  her 
only  sister  is  dead.  Her  mother 
is  a  seamstress  and  is  very  poor, 
but  \'iola  was  kept  in  the  Chi- 
cago public  schools  until  she 
reached  the  sixth  grade. 

Physically,  Mola  is  about  2oyi 
pounds  below  the  normal  in  weight  and  2^  inches  below  in 
height,  with  a  cranial  girth  that  is  i6  mms.  below.  Pier 
lung  capacity  is  too  small  by  33  cu.  in.,  and  her  strength 
of  grip  is  about  half  what  it  should  be,  tho  disproportion- 
ately stronger  with  the  left  hand.  She  has  but  one-fifth 
vision  in  either  eye,  with  normal  hearing. 

\  iola's  face  is  asymmetrical,  the  lips  are  thick  and  are 
draw'U  markedly  to  the  left,  the  chin  is  little  developed  and 
the  mouth  remains  open,  exposing  the  impacted  and  irregu- 
lar teeth.  The  hard  j^alate  is  very  narrow  and  high,  the  left 
ear  is  placed  consideral)ly  higher  than  the  right,  the  head 
tends  to  be  held  to  the  right  and  the  walk  is  rather  peculiar. 
The  nutrition  is  poor,  with  cold  hands  and  feet.  From  time 
to  time  she  has  had  to  have  recuperative  treatment  in  the 
hospital,  and  shows  decided  tendencies  to  tuberculosis. 

Pi  school  A'iola  reads  fluently  and  with  good  pronuncia- 
tion and  intelligence,  spells  and  writes  well  and  composes 
letters  normall}'.  She  does  long  division  readily  and  cor- 
rectly, and  also  some  very  simple  problems  in  fractions. 
Her  music  teacher  states  that  Viola  is  "slow  but  willing, 
takes  an  endless  amount  of  practice  and  then  is  not  sure," 


ci.iNMCAi.  STri)ii-:s  or  iuikih-.k  {'.\si-:s. 


103 


hut  si'C'm>  lo  eiij(i_\  IhiiIi  |i]-aclicc'  ami  k■SMlll^.  She  is  wry 
j^ood  in  l)askc'tr\',  inakiui^  her  nwii  (k'sis^ns  ami  sha])es.  She 
lias  shown  ralher  e\ci']iti<  mal  aplitude  I'm"  \\iM"k  in  lUixleling' 
ami  ])i)Uer\-.  (loiiii;  thi.s  \\i  irk  with  iinderslandnij;'  tho  not 
capahle  ot"  ])nidneini^  much,  ol  herself.  She  is  "easiK'  dis- 
couraged and  ex])ect^  nineh  hel])."  She  attends  well  ti  >  work 
that  slie  likes,  hut  is  inclined  to  he  ])ee\-ish  in  calistlienics 
and  _y\ninastics.  She  has  an  unly  moderate  amount  of  .gen- 
eral information,  hut  talks  intelli^entlx  ahout  j^eneral  ati'airs. 

\  iola  i)a>ses  all  the  llinet  test.s 
thru  12  xears,  except  the  repeti- 
tion of  7  numerals.  I'.esides  she 
was  ahle  to  state  "ditierenci's  l)e- 
tween  ahstract  terms  of  similar 
sound  or  meaniuL;-."  1  ler  mental 
span  was  frail,  iisinilly  insufficient 
for  even  5  numerals  or  2')  syllahles. 
In  the  written  tests  she  used 
ca])itals  and  marks  correctly  ex- 
ce])t  within  her  ])ara,Q"ra])hs.  where 
they  were  usualK'  omitted.  I'rac- 
ticall\-  her  only  mis-si)ellings  were 
inadvertent  omissions  or  traiis- 
])ositions  of  letters.  1  ler  com- 
position "makes  sense"  always  and 
normally,  harring-  an  unusual  state- 
ment or  two.  Iler  re])roductions 
of  stories  show  no  variations  from 
the  text  that  would  suggest  imagination  or  constructive 
tendency,  hut  they  are  ordinariK-  full  reproductions  with 
only  an  occasional  mis-statement.  Her  tlying-machiue  stor\- 
of  131  words  shows  a  little  real  imaginative  ahility  :  She 
flew  low  so  she  could  see  things,  and  saw  children  coasting 
on  their  Xmas.  sleds.     (  )ne  was  trxiui-  onl  InS  nt'w  do;^-  for 


vioL.v  ir. 


I04  BACKWARD  AND  FEEBLE- MINDED  CHILDREN. 

a  horse.  She  compares  coasting  with  flying-,  etc.  Her  re- 
sults in  the  written  tests  are  rather  superior  to  those  of  all 
the  other  children.  The  frequent  "omissions"  in  crossing 
A's  arose  from  her  attempt  to  make  one  mark  serve  for 
several  A's  when  found  together.  Her  tapping  rate  is  near 
the  normal,  with  little  irregularity  of  performance  except 
that  the  left  hand  was  hadly  controlled. 

In  all  the  tests  Viola's  replies  and  conversation  were  en- 
tirely normal  and  sensible,  and  she  showed  a  normal  appre- 
ciation of  wherein  she  failed.  She  gave  evidence  of  having 
an  intelligence  that  worked  normally  within  the  simple 
sphere  in  which  she  is  at  home,  and  when  no  very  difficult 
tasks  were  to  be  performed.  But  she  gives  evidence  of 
frailty  and  weakness  in  her  mental  as  in  her  physical  con- 
dition, and  this  weakness  appears  in  lack  of  control  when 
under  mental  stress.  Her  home  physician  reported  that  her 
moral  nature  was  "weak"  on  the  side  of  sex,  and  that  "if 
not  restrained  she  was  sure  to  get  into  trouble."  Her  low 
vitality  and  plain  appearance  of  course  lessen  the  latter 
danger.  Viola  will  continue  to  need  constant  medical  super- 
vision, and  it  is  again  the  case  of  a  girl  of  relatively  normal 
but  frail  intelligence  and  weak  physique  who  should  con- 
tinue to  find  a  home  in  the  institution  unless  adequate  and 
permanent  home  care  and  direction  can  be  assured  her  else- 
where. 


Cl-lXlCAL  STdDlKS  OF  r.OkDKR  CASES. 


105 


Clorcncc  ./.,  Ai^c  'J^ivclrc  Years. 


CASE  19.— Morally 
Unstable.  Intelli- 
gence nearly  Normal. 
Thieving,  Stubborn- 
ness, and  Fits  of 
Temper.  A  Case  for 
Parental  Discipline. 


The  "moral   iiiil)cci!c"   is  rcg-iilaiiy   a  mental   imbecile  as 
well,  and  abnormal   moral  ]K'rversity   is  not    found   in   isola- 
tion in  anv  case  thai   1  lia\e  found  at  Lincoln  or  that   I  have 
studied  an_\\\bere.     it  is  to  be  re- 
membered,   however,    that    chil- 
dren who  are  not  dehcient   men- 
tally    will    ordinarily    not    arrive 
at  such  an  institution,  whatever 
their     morals.        The     (|uestion, 
therefore,   of  the   possible   isola- 
tion of  moral  perversion  is  pre- 
judged for  such  institutions,  and 

demands   more   thoro   clinical    study   elsewhere   than    it   has 
hitherto  received. 

Clarence  A.  is  one  of  our  tliirty-two  selected  "Ijright ' 
children  who  is  notable  mainly  for  petty  thieving  and  for 
truancy.  Admitted  in  August,  1908,  his  home  record  shows 
that  there  has  been  some  paralysis,  heart  disease,  and  ner- 
vous instability  in  his  near  ancestry.  The  father  was  intem- 
perate and  his  mother's  health  was  poor  before  the  child's 
birth.  Clarence  is  said  to  have  been  peculiar  from  liirth, 
not  sleeping  well  and  having  fainting  spells  and  great  dis- 
plavs  of  temper.  He  was  pronounced  feeble-minded  l)y  a 
physician.  He  had  ear  trouble,  bad  sex  habits,  and  is  said 
to  have  been  destructive  and  stubborn  and  not  to  care  for 
or  fear  anything.  He  began  school  very  early,  but  "did 
not  seem  to  learn." 

Physically  Clarence  is  over  8  pounds  belcjw  in  weight  and 
nearly  2  Inches  below  in  height.  His  cranial  circumference 
is  18  mms.  below  and  he  is  somewhat  inferior  in  strength 
of  grip  and  in  lung  capacity,  but  with  normal  vision  and 
hearing.     His   tonsils   were   somewhat  eidarged   and  there 


Io6  llACKWARD   AND   l'l<:i':l!LK-M  I  X1)I-:D  CIIlI.DREN*. 

were-  iKT\()ii^  in()\eiiK-nls  of  the  liaiuls  when  exleiidcd.  The 
inedical   examination    found   nothino-  noteworthy. 

In  school  Clarence  reads  well  and  with  understandinj;-  in 
the  third  reader,  and  knows  the  tahles  Init  does  not  divide, 
tho  he  can  do  some  simple  problems  in  fractions.  He  spells 
and  draws  well,  was  "original"  in  kindergarten  work,  and 
did  well  in  calisthenics  and  dancing.  He  attends  normally 
but  gets  on  only  fairly  with  others,  being  very  stubborn. 
As  his  "worst  faults"  are  mentioned  "temper  and  stealing." 

The  Binet  tests  give  ( 'larence  a  mental  age  of  \  i  years, 
showing-  but  one  year  of  retardation.  He  could  not  tell  the 
time  from  a  watch  or  clock,  but  distinguished  line-lengths 
that  differed  by  only  (ine  millimeter.  I  le  thought  of  and  gave 
71  words  in  three  minutes,  but  alxnit  half  of  these  words 
were  suggested  bv  similarities  of  sound.  His  responses  and 
conduct  during  the  testing-  showed  intelligence,  but  he  lacked 
energy  in  speech  and  action.  He  is  jiolite  and  genteel  in 
manner,  with  something  even  of  the  "aristocrat"  in  his  bear- 
ing. He  learns  readih'  in  starting  with  band  work,  and  can 
doubtless  g'o  consideraljly  further  with  school  work,  l^n- 
fortunately  for  our  study  the  boy  was  early  removed  to  his 
home. 

This  bov's  thieving  was  inveterate,  and  this  moral  insta- 
bility comes  nearer  to  being  isolated  or  the  main  feature  in 
this  case  than  in  any  other  of  the  cases  that  were  specially 
observed.  lUit  there  is  also  the  usual  slight  retardation  of 
intelligence,  and  besides  there  is  the  truancy  and  marked 
stubbornness  with  tits  of  temper.  It  is  a  case  of  slight  men- 
tal backwardness  with  moral  instability,  the  whole  amount- 
ing to  hardly  more  than  an  extreme  variation  of  normal 
childhood,  and  calling  for  adjustment  by  parental  discipline 
with  the  intelligent  co-operation  of  the  trained  teacher  of  a 
special  class. 


(I.INICAI.  SI'l'DIKS  ()1-    I'.OkDl-.K  CASF.S. 


to: 


ciiArri'.K   i\'. 
C1,I.\KAL  SriDM'.S  (  )1"  \'>(  )K\)\-:\<  CASI^S. 


W'e  have  now  studied  one  or  more  rci)reseiitati\'es  of  eac'n 
of  the  main  ""^roniis"'  to  wliieli  the  thirt\-livc  selected  cases 
mav  he  tlioui^lit  of  as  l)elon^ini:-,  ilie>e  groups  hein^-  hriefly 
characterized  in  ('hai)ter  \'.  The  remainder  of  the  cases, 
as  presented  in  tlie  i)resent  clia])ter,  further  ilhistrate  the 
various  |)hases  of  defect.  The  somewhat  fidl  i)resenlation 
of  man\-  n\  tlie  precedint^-  cases,  seiectetl  as  more  or  le.>s 
tv])ical.  makes  it  necessa.rw  in  the  followint;-,  to  (hscnss  rather 
l.)rien\-  some  cliil<h-en  who  woidd  (|uite  re])ay  fuller  stud>. 

Sfiiiilcy  !K.  . /,;'"r  lilc-iCii  and  Oiic-lialf  ]'riirs. 

Stanlev  1).,  a  little  C'hica^-o  ho\'  who  has  heen  at  Lincoln 
a  year,  is  tvpicalK'  unstahle  morall\-  and  mentally.      \othin,i;' 
especiallv  unfavorable  is  known  of  his  h.eredit\.  hut  Stanle\- 
is  said  to  have  been  peculiar  from 
birth  and  "was  not  acting-  ri^ht 
from  earl\-  childhood   on."      Mis 
head    ai)])eared    small    and    fore- 
head   low.   he  did   not   talk    until 
three  \ears  of  aije.  and  early  be- 
gan to  lie  and  steal.     1  le  would 

also   trv   to   run   away.      lie    at- 
tended school  more  or  k'ss  since  his  seventh  \ear. 

Phvsicallv,  .^tanle\-  is  4  ])omids  above  in  weii^ht  and  is 
nearh'  normal  in  heii.iht.  llis  cranial  girth  is  1)elow  normal 
to  the  significant  extent  of  33  mms.  and  the  forehead  is  low 
with  the  hair  encroaching  u])on  it.  The  forehead  is  dee])ly 
wrinkled  and  the  face  has  an  expression  that  suggests  cruelty 
or   at    least    unrest.      The    medical    examination    showx'd    no 


CASE  20.— Unsta- 
ble Mentally  and 
Morally.  Thieving, 
Lying,  and  Violence. 
Defective  Motor  Con- 
trol. 


I08  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

physical  stigmata  except  an  adherent  foreskin  and  a  con- 
dition of  bronchitis.  He  has  later  had  a  chronic  purulent 
otorrhea  on  the  right  side,  with  discharge.  He  walks  with 
liead  down  as  if  concerned  about  things,  has  a  peculiar  scowl 
or  frown  by  times,  and  seems  over-serious  generally. 

In  school  Stanley  reads  monotonously  in  the  second  reader, 
can  scarcely  multipl}-  by  small  digits,  is  awkward  and  unin- 
terested in  calisthenics,  and  is  poor  at  dancing.  ?Ie  is  said 
to  be  inattentive,  but  he  makes  an  appearance  of  keeping 
busily  down  to  work. 

The  Binet  tests  give  him  a  mental  age  of  io>4  years,  an- 
other case  of  but  one  year  of  retardation.  He  could  never 
repeat  five  numerals  and  could  not  count  the  value  of  stamps 
or  "make  change."  He  could  detect  none  of  the  nonsense  in 
sentences,  and  could  make  no  definitions  except  in  simple 
terms  of  use. 

From  time  to  time  Stanley  has  been  in  trouble  for  steal- 
ing and  lying.  He  has  also  run  away  at  least  once.  More 
serious  still,  on  two  occasions  he  has  struck  playmates  with 
rocks,  on  one  occasion  injuring  considerably  the  eye  of  the 
boy  knocked  down  by  the  stone.  Questioned  about  the 
latter  experience  he  first  denied  it  variously,  then  admitted 
it ;  but  in  trying  to  tell  why  he  did  it  he  convinced  me  that 
he  did  not  know  himself.  The  boys  had  been  playing  "cow- 
boy," and  Stanley  was  excited  and  threw  wildly.  The  other 
boy,  he  says,  had  hit  him  on  the  legs  with  a  switch,  "and  it 
hurt."  The  boy  who  was  struck  says  that  Stanley  did  not 
mean  to  injure  him,  that  he  looked  around  suddenly  or  the 
stone  would  not  have  struck  his  eye. 

It  seems  that  lack  of  motor  control  rather  than  vicious- 
ness  may  be  back  of  Stanley's  violence,  and  indeed  he  seems 
to  lack  control  of  his  imagination  as  of  his  actions.  His 
facial  expression  is  under  no  better  management.  He  looks 
me  in  the  eyes  with  a  strained  appearance  of  earnestness 


CI-IMCAI,  STUI)I1-:S  OF  lUjKDI-.R  CASKS.  lOQ 

wliicli  does  not  var_\-  wiili  my  own  expression  and  witli 
tile  demands  of  the  situation.  1  look  u])  at  him  with  a  smile 
of  relief  from  the  fatii;iie  of  writing-,  hut  he  meets  my  gaze 
with  not  even  a  faint  smile  in  res])onse.  His  over-serious 
faee  shows  marked  over-aetion  of  the  frontal  muscles,  and 
a  tortuous  sort  of  corrugation  seen  especiall}'  when  he  tries 
to  do  mental  work. 

I'urther  tests  and  ohservations  were  ])revented  hy  ihc 
family's  removing"  the  hoy  from  the  institution.  Tho  hut  a 
year  retarded,  Stanley's  instaliility  of  neuro-muscular  con- 
trol will  prohably  continue  to  put  him  at  variance  with 
society. 


1  lO 


liACKWAKD   Ai\U   i-EEnLli-AllNDliU   CllILDRKX 


Milton  ./.,  .Igc   Thirteen   and   One-half   I'cars. 


CASE  21.— Unsta- 
ble. Truancy,  Vag- 
rancy, and  Thieving. 
Deficient  in  IVIotor 
Control  and  in  Mimic. 


Milton  is  a  t}i)ical  truant  and  vagrant.  .Vdinitted  in  Anril, 
1910,  lie  is  stated  to  be  of  alcoliolic  parentage  on  one  side, 
with  feeble-niindedness  and  tuberculosis  in  the  family.     The 

child  is  said  to  have  wandered 
away  since  his  third  year.  He 
was  sent  to  school  from  his  sixth 
}ear.  but  was  a  truant,  was  at  a 
reform  school  later  as  a  delin- 
quent, and  was  there  finally  pro- 
nounced defective  and  sent  to 
Lincoln.  His  mother  states  that 
the  boy  would  "play  hookey"  instead  of  going  to  school  and 
would  stay  away  several  days,  apparently  sleeping  out  when 
it  was  not  too  cold.  She  states  that  he  went  off  continually, 
school  or  no  school,  and  that  "no  one  will  keep  him  over 
night  any  more."  He  always  looked  up  the  worst  boys  he 
could  find,  and  "won't  work  for  nobodv"  as  she  ])Ut  it.  "As 
soon  as  he  gets  his  breakfast  he  walks  off  and  don't  return 
till  eight  or  nine  o'clock."  He  craves  tobacco  and  has 
chewed  it  since  he  was  (juite  small. 

Physically  Milton  is  near  the  normal  in  weight  and  height, 
w  ith  a  head  that  is  over-large  by  16  mms.  of  circumference. 
The  head  is  developed  mainly  in  the  back  and  to  the  left, 
causing  a  marked  asymmetry.  He  is  a  little  below  normal 
in  strength  of  grip  and  in  lung  ca])acitv. 

The  mouth  is  unusually  small,  the  ])alate  a  little  higli,  the 
ears  are  unlike  and  the  right  ear  is  pointed  sharply.  The 
fingers  take  distorted  sha])es  when  s]iread  apart,  contracting 
variously  without  his  control  or  ap])arcnt  knowledge.  The 
\'isual  acuity  is  normal,  the  hearing  is  (|uitc  defective  in  the 
left  ear.  F'.ex-ond  a  hospital  record  iram  pnetuuonia  the 
medical  findings  are  not  important. 


CLiMcAi.  SI  ri)ii-;s  oi'  i'.()K1)i;k  casks.  i  i  i 

ill  school  Milloii  is  inaUciUivc  U)  his  work  and  to  his 
Icachcr.  lie  can  read  only  the  sinii)lest  second  reader  selec- 
tions, with  elTort  and  tre(|nenl  i'rror>.  lie  does  ^iini)le  addi- 
tion and  suhlraclion,  hut  i^  |)raclicall\'  heli)le>>  heyond  this. 
lie  is  ver\-  nnsatis factor)-  in  manual  training,  as  he  will  not 
stick  to  or  linish  an\-  task.  Mis  drawin;.^-  teacher  was  able 
to  get  some  fair  work  from  him,  and  lie  does  well  in  cali>- 
thenics  hut  re(|uires  firm  control,  lie  could  name  no  state 
other  than  Illinois.  iJesides  the  l\evolution.ar\-  War,  he 
stated,  the  Tniled  .States  had  the  I'.lack  I  lawk  War  and  the 
"Civilized  War."  lie  d()es  not  know  "what  counlr_\-  they 
did  fight  last  with." 

Mentalh  .Milton  earns  a  rating  of  i  i  years  of  mental  age, 
with  a  retardation  of  2'2  _\-ears.  When  asked  to  write  from 
dictation  "The  j^'cttx'  little  girls,"  he  wrote  it  "Tlie  pettry 
Ittle  girles."  I  le  was  weak  on  re])roducing  numerals.  Thru- 
out  the  testing  his  attention  and  interest  were  unfailing.  I  le 
staid  faithfidly  by  his  tasks,  even  when  these  re(|uired  con- 
siderable effort,  and  he  tried  to  please  and  accomnKKlate. 
His  talk  was  sensible  and  showed  many  marks  of  intelligence. 
In  playing  ball  with  me  later  he  disregarded  the  ])aiu  of  in- 
jured fingers,  and  played  with  enjoyuient  tho  with  less  \  im 
and  energ}-  than  is  shown  1)\-  most  normal  bo\>.  lie  made 
many  comnion])lace  remarks  but  no  absurdities,  lie  likes  to 
"captain"  the  calisthenics  class  and  does  well  e)n  such  occa- 
sions. At  other  times  he  is  apt  to  keep  the  room  in  an  up- 
roar. 

The  secret  of  Milton's  dissatisfaction  with  school  and  of 
his  restless  wanderings  seems  to  lie  in  his  defective  motor 
control.  In  school  1  noted  thai  when  he  was  interested  he 
ke])t  making  slighl  choreiform  twitchings.  All  his  move- 
ments seem  to  lack  normal  control.  They  begin  and  end 
suddenly.  There  is  no  gradual  warming  up  or  slowing 
down,  but  the  look  is  sudden,  the  inovcment  of  hand  or  foot 


112  BACKWARD  AND  FEEBLE-MINDED  CHILDREN. 

starts  and  ceases  without  warning.  His  eyes  have  an  odd 
look,  and  their  furtive  movements  suggest  those  of  a  fox 
or  wolf.  Their  expression  does  not  respond  normally  to 
the  gaze  of  another,  is  out  of  accord  with  the  other's  look 
and  with  the  given  situation.  Pie  looks  either  too  fixedly  or 
too  shyly,  with  slight  incoordination  of  the  eyes  and  with  a 
half-fearful  expression.  The  facial  expression  is  too  sober 
and  strained,  and  is  badly  inter-coordinated :  The  smile  of 
the  mouth  may  be  apropos  enough  while  the  eye  looks  star- 
ing and  cold.  The  incoordination  of  facial  movements  shows 
markedly  when  he  is  asked  to  watch  an  object  moved  before 
the  eyes. 

When  reading  or  when  writing  dictation  Milton  was  never 
still.  To  quote  from  my  original  observations,  his  "eyes 
close  a  little,  head  turns  slightly  to  side,  body  straightens, 
eyes  wink  several  times  in  succession,"  etc.,  typical  of  a 
stream  of  quick  movements  going  on  constantly,  while  he 
made  errors  at  every  line,  backing  up  and  trying  it  again 
with  difficulty  but  with  good  effort.  One  can  see  that  this 
must  be  fatiguing,  and  in  the  end  work  that  is  thus  subject 
to  constant  error  must  bore  the  best  of  pupils. 

Further  observation  and  tests  and  the  study  of  his  con- 
tinued thieving  propensities  were  prevented  by  Milton's  run- 
ning away  from  the  institution,  and  no  more  has  been  heard 
of  him.  It  is  an  interesting  case  of  an  unstable  child  with 
strong  tendency  to  vagrancy  associated  with  criminality.  The 
mal-coordinations  and  the  kaleidoscopic  shiftings  of  neuro- 
muscular equilibrium  have  correlated  with  them  an  inability 
to  persist  in  at  least  the  school  kinds  of  work,  with  a  restless- 
ness that  must  have  its  expression. 


Cl.l  MLAl,  SIIDII'IS  Ol'"  I'.OUDKR  CASES. 


I '3 


Hilda  11.,  CoU>rcd,  .h'c  Ttcclvc  Years. 


CASE  22.— Unsta- 
ble. Fighting.  Steal- 
ing, Lying.  Deficient 
Control  of  Temper 
and  Movement.  Kera- 
titis. 


I  lilda  E.,  at  the  institution  since  l'^el)ruary,  KJOQ,  is  of  im- 
knowii  Chicaijo  parentag^e.    Deserted  by  her  mother  she  was 
placed  in  the  care  of  the  juvenile  Court,  and  thus  reached 
Lincoln.     She  was  stated  to  have 
bad  sex  habits,  to  have  a  record 
of    stealin,q;,    and    to    have    been 
treated  for  "specific  iritis"  in  an 
eye  and  ear  infirniary. 

Physical  examination  shows 
Hilda  to  be  about  normal  in 
weight,  height,  cranial  measure- 
ments, and  strength  of  grip,  but  distinctl}'  Iselow  in  lung  ca- 
pacity. Her  head  has  some  irregularities,  with  forehead  nar- 
row and  rather  low  and  receding,  and  with  the  seal])  thick 
and  fleshy  in  front.  The  nose  is  low  and  broad.  ])alate  rather 
high,  obliquity  of  the  eyes  not  (juite  normal,  ears  small  and 
abnormally  formed.  Medical  examination  has  found  noth- 
ing al)normal  except  "an  acute  keratitis  of  left  e}'e,  ]^rol)ably 
specific."  This  has  become  chronic  and  seriously  threatens 
her  sight,  tho  she  still  has  one-half  vision  in  the  right  e}'e 
and  two-thirds  in  the  left  eye.     I  Tearing  is  normal. 

In  school  Hilda  reads  poorl\-  in  the  first  reader,  add<  and 
subtracts  a  very  little,  is  "jioor"  in  spelling,  writing,  and  in- 
dustrial work,  but  dances  well.  She  gives  only  momentarx' 
attention  to  anvthing,  gets  on  onlv  fairly  with  others,  and  her 
worst  school  fault  is  stated  to  be  her  insistence  on  l)eing  the 
center  of  attraction.  She  is  most  restless,  and  "alwa\s  sits 
on  one  leg  or  twisted  around  in  her  seat."  She  a|)pears 
bright  and  lively,  even  spontaneous,  but  she  does  not  get  the 
work  done.  She  is  over-demonstrative  of  her  afifection  for 
persons  whom  she  likes. 

The  Binet  tests  give  her  a  mental  age  of  Sj/j  years,  a  retard- 


114 


UACKWAKD   AND  FEi:ULK-AI  INDED  CHILDREN. 


ation  of  2  years.  She  could  not  repeat  16  syllables,  could  not 
count  stamps  nor  backward  from  20  to  o,  could  not  write  a 
four-word  phrase  when  heard,  could  not  p;ive  the  date  even 
a])proximately,  nor  make  chano:e,  name  the  months,  or  ar- 
ran.t;"e  weights. 

Hilda  has  learned  to  write  with  moderate  legibility,  but 
cannot  use  writing  to  any  purpose.  In  trying  to  reproduce 
stories  I  and  II  and  to  write  of  a  trip  in  a  Hying-machine, 

she  wrote  9,  6,  and  4  lines  re- 
spectively, being  a  hotch  potch 
such  as  "a  fat  pig  a  hoig  to 
leand  a  good  heven  Cand  a 
sometime  cand,"  etc.  Instead 
of  writing  similars  and  oppo- 
sites,  in  the  tests  for  these,  she 
either  copied  the  words  with 
strange  trans}>ositions  and 
clianges.  or  occasionally  wrote 
some  apparently  imrelated 
word  or  series  of  letters.  She 
crossed  49  and  77  A"s  in  two 
minutes  each,  with  no  errors. 
Her  tapping  record  counted  to 
nearly  normal,  but  she  showed 
exceedingly  poor  control,  tens- 
ing her  fingers  into  knots, 
hammering  the  key.  etc.  She 
sometimes  became  so  awkward  and  her  muscles  would  be- 
come so  tensely  knotted  that  she  could  hardly  continue  tap- 
ping even  when  coached. 

Of  a  kind  with  these  results  of  the  tests  for  motor  con- 
trol is  Hilda's  conduct  when  crossed  or  angry.  The  attend- 
ants report  that  she  has  violent  fits  of  temper  in  which  she 
throws  lierself  on  the  ground  and  butts  lier  head,  and  she 


ail 


n  J 


HILDA    E. 


C'l.iNJCAi.  STn)ii;s  oi-  i;(iki>i:k  r.\S]':s.  115 

somctiiiK's  kicks  ])layniatcs  scvcrcl}-  and  doe.v  ihcm  oilier 
violence.  She  continues  lier  record  of  fighting'  and  also  of 
stealing"  and  lying. 

We  have,  then,  a  case  of  imstahlc  motor  and  mental  con- 
trol shcjwn  in  the  almost  convulsive  manifestations  in  the 
motor  tests  and  in  the  fits  of  tem])cr  and  of  violence:  shown 
e(|ually  in  her  restlessness  and  weak  attention,  and  possihly  in 
her  inability  to  mentally  direct  her  movements  of  writing. 
With  the  deep-seated  infection  shown  in  the  keratitis,  with 
her  bad  habits  sexual  and  othcrwist'  and  her  inal)ilit\-  to  jirofit 
l)y  instruction,  she  is  evidently  l)esl  cared  for  in  an  inslilution. 
in  spite  of  the  small  amount  of  intelligence  retardation. 


CASE  23. —  Emo- 
tionally Unstable. 
Tuberculous  Hered- 
ity and  Condition. 
Keratitis.  Fair  In- 
telligence. 


Il6  UACKWAKD   AND  FEEBLE-MINDED  CHILDREN. 

]  Villi  a  C,  Age  Thirteen  Years. 

The  home  record  of  Wilda  C,  who  was  admitted  in  Jan- 
uary, 1909,  shows  that  eight  of  her  brothers  or  sisters  have 
died  from  causes  not  stated,  and  that  two,  with  her  mother 

and  grandfather  have  died  of  tu- 
berculosis. There  is  little  else 
reported  of  her. 

Wilda  is  above  the  normal  by 
nearly  11  pounds  in  weight  and 
2.8  inches  in  height,  but  is  slight- 
ly below  in  cranial  girth,  strength 
of  grip,  and  lung  capacity.  She 
has  but  one-fifth  vision  in  the  right  eye  and  two-thirds  in  the 
left,  with  normal  hearing.  Her  forehead  is  rather  low,  the 
eyebrows  are  high  arched  and  unite  low  on  the  nose,  giving 
a  peculiar  oblique  effect  to  the  face.  The  two  upper  in- 
cisors are  separate  but  well  developed,  the  tooth  on  each  side 
being  poorly  developed  and  small.  The  medical  examination 
shows  a  poorly  nourished  liody,  oral  breathing,  narrow  chest, 
and  weak  lungs.  There  is  slight  enlargement  of  the  heart 
and  some  abnormality  of  its  action.  She  was  considered  to 
have  tuberculosis  of  the  lung,  with  "corneal  ulcer,  probably 
tu1)crcular."  The  latter  condition  is  one  of  chronic  keratitis 
which  has  clouded  and  caused  irregidarities  of  the  cornea. 

In  school  Wilda  reads  well  in  the  fourth  reader,  does  long 
division  and  addition  and  subtraction  of  fractions,  and  is 
said  to  spell  well  and  to  draw  "normally."  She  is  a  little 
awkward  in  calisthenics  and  does  but  fairly  in  dancing.  Be- 
sides she  is  making  a  little  progress  with  history,  physiology, 
and  music,  but  finds  geography  difficult.  She  "attends"  as 
well  as  normal  children,  gets  on  well  with  others,  and  her 
worst  school  fault  is  stated  to  lie  that  she  "likes  to  be  made 
over"  and  "is  jealous  about  getting  her  share  of  smiles," 


CLlNICAr.  STUniF.S  OF  IlOKI)|",R  CASKS. 


The  r.iiK'l  L'xaiiiiiKitioii  mixes  Wilda.  a  iiieiUal  a.^e  oi"  il.  a 
retardation  tliiis  n\  i)iit  one  yeai".  It  was  notieealile  lliat  slu' 
conkl  not  c-lian^e  4e  ]"roni  j^c.  eonld  not  re])rodnec  C)  of  i<) 
details  read  to  hrr,  nor  deteii  ineoni^rnities  in  scntenees.  She 
could  not  eonstruet  a  sentenee  of  j;  ^ix-cn  words  and  failed 
to  rearran.^e  the  shuffled  words  of  st'Utenees.  She  volunteers 
a  good  deal  of  information  learned  in  sehool,  staling  it  cor- 
rectly. 

W'ilda's  good  showing  in  the  re])rodnetions  of  stories  1  and 
11  and  especiall}-  in  stor\-  invention,  also  in  the  .\-tes1  and  in 
the  giving  of  similars,  corres])(inds  to  the 
findings  with  the  l^>inet  scale  hut  wouM 
after  all  he  weak  for  a  normal  child.  The 
story  invented,  however,  does  show  some 
imaginative  ahility  and  sonu'  ])i>wer  of  us- 
ing images  to  a  purpose. 

Her  writing  is  legihle  hut  ])rimitive. 
She  omits  or  misuses  ])unctuation  marks, 
uses  the  infinitive  for  the  past  tense,  etc. 
Her  composition  is  child-like,  with  primi- 
tive couplings  up  and  repetiti(^ns  of 
"and",  and  the  occasional  omission  of  a 
word  apparently  from  distraction.  Her 
si)elling  is  normal  hut  careless.  Her 
thought  is  generally  natural  in  its  se- 
quences, tho  she  made  the  statement  "P 
hegins  with  prevent  and  E  hegins  with  event,"'  when  asked 
to  distinguish  these  words. 

The  tapping  tests  showed  a  normal  total  with  the  left  anl 
26  below  with  the  right.  But  the  work  was  irregular,  and 
showed  defective  control  in  the  frecjuent  knocking  and  ham- 
mering. 

Wilda's  actions  in  the  presence  of  the  opposite  sex  indi- 
cate that  she  has  an  abnormal  deficiencv  of  control  of  her 


WILD  A    C. 


Il8  BACKWARD   AND   FEEBLE-MINDED  CHILDREN. 

sexual  nature,  and  she  would  seem  to  have  bad  sexual  habits. 
Her  attendant  says  emphatically  that  W'ilda  is  "very  fond  of 
the  boys"  and  that  she  is  not  verv  promising.  She  shows 
facile  emotional  reactions  to  boys  and  men,  and  tendencies 
to  over-fondness  in  general.  Her  face  becomes  soft  and 
without  character  as  she  looks  up  with  an  ever-ready  smile 
which  bespeaks  notice  and  commendation. 

We  have  here  the  case  of  a  mentally  backward  girl  with 
verv  moderate  mental  furnishings,  but  sufificient  perhaps  for 
a  normal  if  simple  life  in  society.  But  there  is  more  to  be 
considered  than  the  intelligence.  There  is  an  abnormal  lack 
of  emotional  control  and  an  over-tendency  to  the  things  of 
sex,  with  little  development  of  will  or  foresight.  When  one 
adds  to  this  the  tuberculous  history  and  condition,  and  the 
deep-seated  affection  of  the  eyes  which  will  long  need  medical 
attention  even  if  it  should  spare  her  vision,  it  is  seen  that  in 
spite  of  the  siuall  amount  of  intelligence  retardation  this 
girl,  too,  is  well  placed  in  an  institution.  My  latest  report 
received  as  I  write  states  that  she  is  ''doing  well  but  daily 
growing  to  be  more  of  a  flirt." 


ci.iN'icAL  s'lUDiKs  c)i'  I',(ji<i)|-;r  casks. 


IIQ 


Juuiiuc    If.,   .h^c   I'oiirtci'ii    Years 


CASE  24.  —  Dull, 
but  Well  Balanced 
and  Pleasing.  Ap- 
pears Normal. 


Fannie  li.  lias  a  pretty  face  and  an  e\cr-rca(l\-  smile,  an;! 
these  are  probablx-  her  strongest  assets,  often  serving;-  her  a^ 
snhstitutes    for    tliinkini;-.      She    came    lo   the    in>titiui(>n    in 
October.     i<x/).    and    was    re-ad- 
mitted  in   .\])ril,    KjKi.      IJorn    in 
( iermany.    she    did    not    talk    till 
tliree  years  of  a^e,  had  a  hal)it 
of  hiding-  thini^s  and  of  rnnnin^- 
a\va\ .  and  was  accused  oi  ■"warn- 
ing' to  eat  all  the  time."    She  was 

said  to  have  given  trouble  when  with  her  famil\-  and  the\- 
wished  to  be  rid  of  her,  but  little  more  is  known  i)\  her  home 
record. 

Physicall\-  b'annie  has  lagged  l)ehin(l  her  years  in  weight. 
height,  and  strength  of  grip,  but  is  of  normal  cranial  and 
lung  capacity,  and  indeed  is  in  rolmst  ])h\-sical  condition  as 
shown  in  her  medical  examination  and  to  general  obser\a- 
tion.  Her  vision  is  good,  the  hearing  was  dull  in  one  ear 
when  the  test  was  made.  Juid  home  conditions  ma\  ha\e 
caused  the  lagging  in  growth,  as  it  was  noted  that  after  .i 
[)rolonged  stay  with  her  home  peoi)le  she  returned  ill-cared 
for  and  nnich  reduced  in  tiesh. 

In  school  b'annie  reads  "fairly"  in  the  second  reader,  is 
"subtracting,"  and  is  doing  fairly  in  industrial  work,  dancing, 
and  calisthenics,  tho  awkward  in  the  latter  and  in  walking. 
She  "attends"  normally,  "has  a  good  opinion  of  herself." 
and  lier  worst  fault  is  stated  to  be  "stubbornness." 

1  he  r.inet  tests  showed  a  mental  age  of  9^/2,  a  retardation 
of  4  years.  Any  ])roblems  involving  any  use  of  abstract  con- 
ceptions or  the  ideating  of  abstract  situations  were  (|uite 
beyond  her.  She  lacked  ideas  and  was  easilv  confused  in 
handling  what   she  «lid  have.     In   general  she  seemed  bored 


120 


BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 


at  thinking,  but  would  look  up  sweetly  at  me  instead  of  mak- 
ing a  try  whenever  some  intellectual  eifort  was  called  for. 
In  the  written  tests  her  writing  is  very  irregular,  but  can 
be  read.    The  lines  are  of  all  lengths,  with  capitals  and  punc- 
tuation marks  at  random.     She  wrote  but  little,  showing  no 
imaginative    construction    and    making    most    trivial    state- 
ments.    She  spells  "ho"  for  "who," 
"lift"  for  "lived,"  "gard"  for  "gar- 
den," "bouj"  for  "boy,"  "brig"  for 
"bridge,"  "dint"  for  "didn't,"  "siad" 
for     "said,"     "spreank     felte"     for 
"S])ringfield."      Reproducing    "The 
children  knew  how  to  work  the  fly- 
ing-machine,"    she     writes,     "And 
the\'   new    How   too  Work    on   the 
Masliin."    I'he  A-test  showed  many 
(.■rrnrs,  and  the  tests  for  similars  and 
opposites  seemed  beyond  her  com- 
prehension.    She  showed  one-third 
less  than  the  normal  rate  of  tapping. 
The   ninet  finding  of  4  years  of 
retardation  is  thus  confirmed  by  her 
lamentable    failures    in    most    other 
mental  tests  and  by  her  very  slow 
progress   in   school   studies.     Even 
if  her  age  should  not  have  been  cor- 
rectly   stated    by    her    people,    her 
power  to  do  mental  work  evidently 
lags  well  behind  even  her  physio- 
logical  development.      But   this  little  girl   is   pretty  evenly 
balanced  as  far  as  she  goes,  and  is  able  to  make  the  most  of 
her  rather  scantv  resources.     Whatever  she  attempts  to  do 
is  performed  with  fair  efficiency  and  promptness,  and  one 
does  not  note  that  she  attempts  but  little.    There  is  nothing 


FANNIE    H. 


CLINICAL  STl'DIF.S  OI'   l'.(  )KI  )I:R  CASES.  121 

to  attract  unl'a\oral)lc  attentiMii  in  her  ordiiiar}-  l)chavior, 
as  she  is  soeialh'  C(ini])aiiinnahle  and  ready  to  1)e  more  or  less 
Iielpfnl.  tho  i)erhai)s  a  Httle  !az\.  And  it  is  thns  nut  stir- 
])risinf;-  that  witli  her  winning-  face  and  e\-er-ready  smile  slu- 
is  often  thoni;ht  to  he  (jiiite  normal  and  to  l)elon,<4-  outside. 
As  a  matter  of  fact,  if  she  had  a  i^cod  home  she  wonid  cer- 
tainly he  cared  for  in  it.  and  ])roi)erly  ])erhai)s.  Willi  s^ood 
home  conditions  from  the  first  she  miiihl  liave  shown  less 
of  mental  retardation.  Ihit  as  things  are,  while  on  the  ])hys- 
ical  side  Fannie  has  reacted  well  to  proper  hygiene,  mentally 
she  has  not  made  much  ])rog-ress;  and  T  am  inclined  to  con- 
sider this  a  case  of  fundamental  defect  of  mild  degree,  show- 
ing mainly  as  mental  dullness  and  inaptitude  for  any  think- 
ing that  involves  representations  of  the  ahsent. 

Socially,  the  danger  of  leaving  such  a  girl  without  the 
supervision  of  an  institution  or  of  adecpiate  home  direction, 
with  her  winning  ways,  her  physical  vigor,  and  lu'r  marked 
incapacity  for  taking  thought,  is  evident  enough.  And  her 
"normality"  is  that  of  a  much  younger  child,  judged  even 
then  hv  the  standard  of  the  few  things  that  she  attempts 
rather  than  ])\  that  of  th.e  varied  activities  needed  to  live 
normally  at  her  age. 


CASE    25.  —  Dull. 

Poor 

Physique     and 

Vision 

Over-Serious. 

Mildly 

Emotional. 

12-1  BACKWARD   ANI)   FEEn[J-:-.MlNt)EL»  CHILDREN. 

Nora  L.,  Age  Tliirfccii  Years. 

Nora  L.,  of  whose  home  ci:)nditions  ahnost  nothing  is 
known,  was  brought  to  Lincohi  in  February,  1906.  A  tall, 
slender  girl,  she  is  weak  physically,  dull  mentally,  and  has 

an  over-seriousness  of  manner 
and  seclusiveness  of  attitude  that 
would  seem  to  make  of  her  life 
a  sad  monotony. 

Xora  is  a  little  below  normal 
in  weight  and  i  >'2  inches  above 
in  height.  Her  head  is  7  mms. 
below  in  girth,  10  below  in  breadth  and  6  above  in  length, 
giving  a  noticeable  disproportion.  The  head  is  narrow  in 
front,  with  the  forehead  appearing  more  prominent  at  the 
right.  The  li]is  curve  downward,  middle  incisors  are  sepa- 
rate, palate  is  rather  high,  ears  asymmetrical,  skin  pale,  and 
nutrition  poor.  There  is  considerable  strabismus  and  an  un- 
diagnosed affection  of  the  cornea,  with  a  deforming  promi- 
nence of  the  left  e}e  and  vision  of  but  one-tifth  in  either  eye. 
The  hearing  is  normal.  Two  years  ago  she  was  quite  frail 
and  was  placed  on  tonic  treatment  for  tuberculosis.  She  has 
improved  physically,  but  is  still  frail  and  is  probably  tuber- 
culous. 

In  school  Xora  reads  well  in  the  third  reader,  multiplies 
bv  two  digits  and  divi(le^  l\v  but  one,  spells  satisfactorily, 
does  "good"  work  in  drawing  and  "very  well"  in  calisthenics 
and  dancing.  Her  defective  vision  prevents  her  doing  well 
in  sewing.  She  practices  faithfully  at  piano  lessons  and 
takes  various  parts  in  the  entertainments. 

The  Binet  examination  gives  Xora  a  mental  age  of  loj/j 


CI.IMCAL  S'l  Ul)Ii;S  Ol'   liORDl'.K  (  ASES. 


123 


^•cal•s,  a  i-ctardalioii  of  2  _\-ears.  Tlu'  written  tcst->  show  a 
handwriting-  that  is  irrc^uhir,  with  crooked  words  and  lines 
and  rather  infantile  characteristics.  There  is  rarely  a  capi- 
tal or  ])nnctuation  mark.  The  niis-s])ellin^s.  tho  not  frc- 
qnent.  are  of  interest:  stad  (statue),  thouth  ithoui^ht). 
granden  (  s^arden ) ,  einith  (enonyh),  tiled  (fell),  prise 
(present).  Besides,  she  tends  to  use  the  infip.iti\'e  or  parti- 
ciple forms  of  the  verh  everywhere.  1  fer  thonuht  seems  to 
proi^ress  normally, 
tho  simply,  but  she 
cannot  readily  put 
what  she  thinks 
into  written  sen- 
tences. The  total 
output  in  these 
tests  is  very  mea- 
g-er,  rather  below 
what  the  I'.inet  teM^ 
would  indicate. 

Jn  tapping-  Xora 
is  27  iielow  with 
the  ris:^ht  hand  .and 
I  1  above  with  the 
left.  beino-  left- 
handed.  In  this 
test  as  in  others  she 
was  ])assi\'e,  calm, 
with  no  facial  ten- 
sions. With  the 
more  diftlcult  of  the 
Binet      tests       she  NOitA  r>. 

tended    to     remain 
silent,  trying-  but  ■"stuck,"  her  mind  seeming  paralyzed  and 


124  BACKWARD  AND  FEEBLE-MINDED  CHILDREN. 

inactive,  her  eyes  filling  with   tears  and  her  lip  quivering. 
This  was  repeated  over  and  over. 

The  poor  physical  condition,  very  weak  vision,  and  paucity 
of  mental  resources,  with  the  over-seriousness  of  demeanor, 
render  this  case  rather  unpromising,  tho  recent  school  re- 
ports show  some  progress. 


CLJNJCAl.  STUDIICS  Ol'  1!0KI)1:K  CASES. 


llanict  C,  A'^c  lilcvoi  Years. 


CASE 

26. 

—  Insan- 

ity  and 

Fee 

ble-Mind- 

edness  in  th 

e  Family. 

Keratitis. 

Pneumo- 

nia.     Br 

qht 

and    At- 

tractive. 

Harriet  is  a  really  bri^-ht  and  sweet  little  girl,  a  star  at 
the  school  entertainments  and  a  favorite  with  everyone. 
The  question  as  to  her  normality  has  often  been  discussed. 
Admitted  at  the  age  of  six  or 
seven,  her  family  record  is  un- 
promising. A  grandmother  of 
weak  intelligence,  a  mother  in- 
sane since  adolescence,  a  father 
reported  to  have  been  "simple" 
and  worthless,  and  the  child  her- 
self apparently  born  out  of  mar- 
riage and  brought  to  the  in^tilution  after  a  severe  attack 
of  typhoid, — this  sums  up  the  stor\ . 

Physically  Harriet  is  somewhat  above  normal  in  weighl 
and  height,  slightly  below  in  cranial  girth,  ([uite  inferior  in 
lung  capacity,  and  nearh-  normal  in  strength  of  gri]).  There 
are  no  bodily  stigmata  and  the  head  and  face  are  well  (k'- 
veloped,  but  the  front  teeth  show  a  rather  inferior  develo])- 
ment.  For  several  years  Harriet  has  had  serious  trouble 
with  her  eyes,  diagnosed  as  interstitial  keratitis.  This  causes 
some  corneal  opacity  and  irregularity  and  at  tiiues  threatens 
the  sight  of  one  or  both  eyes.  Her  vision  is  less  than  one- 
fifth  in  either  eye.  She  also  has  "smiffles"  continually  and 
breathes  thru  her  mouth,  but  has  had  no  exploratory  exami- 
nation for  adenoids.  She  has  very  frec|uent  colds,  gets  in- 
fected easily  in  toe  nails,  lingers,  etc.,  and  shows  low  vitalit\ . 
.She  is  subject  to  gastric  disturbances  and  sudden  high  tem- 
])eratures,  and  worst  of  all  has  had  severe  attacks  of  acute 
bronchitis  and  pneumonia. 

In  school  Harriet  reads  quite  well  in  the  third  reader, 
does  addition  and  sul)traction  and  some  of  the  tables,  is  not 
careful  or  neat  in  industrial  work,  but  is  graceful  in  calls- 


126 


UACKWAKD   AND  FKliBLE-M  INDliD  CHILDKriN, 


tlienics  and  dancing.  She  attends  well  to  her  teachers,  but 
not  so  well  to  her  work,  of  which  she  soon  tires.  Little 
wonder,  in  trying  to  do  near  work  with  less  than  one-fifth 
vision  and  no  glasses !  She  gets  on  well  with  others  and  is 
not  credited  with  any  special  faults  or  wath  any  special 
aliilities. 

The  Binet  examination  gives  Harriet  a  mental  age  of 
9/<2,  while  her  age,  based  only  on  the  estimate  made  when 
she  was  admitted,  is  between  lo  and  ii,  most  probably  the 
latter.  She  was  unable  to  name  common  pieces  of  money, 
could  not  change  4  cents  from  25  cents,  defined  horse  as 
"What  you  ride  on.  what  rides  a  bugg}',  its  got  legs,"  and 
could  not  define  any  words  in  other  terms  than  use.  She 
could  not  tell  the  time  from  watch  or 
clock.  She  attends  well  and  makes  nor- 
mal ada|itations  so  far  as  she  attem]:)ts 
an\-,  but  tends  to  silence  if  the  question 
is  difficult  and  is  over-mild  and  inag- 
gressive  in  manner,  b^ven  when  emo- 
tion occurs  it  is  mildl_\'  expressed. 

In  tlie  written  tests  Harriet's  writing- 
is  irregular  and  primitive,  often  illeg- 
ible. .Sjie  uses  no  capitals  or  punctua- 
tion marks,  and  obscures  her  meaning 
l)y  omitting  words  and  letters,  making 
also  some  illiterate  mis-spellings.  How- 
ever, her  simple  sentences  show  speecii 
habits  that  are  normal  for  a  }-()ung 
child,  and  it  may  be  mentioned  that  she 
talks  a  great  deal  when  well  acquainted, 
though  bashful  otherwise.  She  repro- 
duced correctly  22  and  Jfi  details  of  stories  1  and  11,  but  coul  I 
think  of  nothing  for  the  ll_\'ing-machine  tri];).  She  crossed 
17  and  then  51   A"s  in  successive  tests  of  2  minutes  each, 


iiai;i;ii;t  g. 


CLJxicAi.  s'lUDii'.s  oi-  r,iiKi)i:i<  CASES.  127 

with  nu  errors.  1'eii  similars  were  correct  and  ^]  incorrect, 
12  opposites  correct  and  1  incorrect,  in  the  ii-niinnte  tests 
for  these.  In  tap])inL;  she  went  a  little  l)e\ond  the  normal 
rate. 

On  tlie  whole  the  mental  tests  establish  the  t'act  of  a 
certain  amount  ot  mental  backwardness,  not  amounting'. 
however,  to  feeble-nn'ndedness.  In  jud<4"in^-  further  of  such 
a  case,  we  have  to  consider  it  in  its  collective  aspects.  There 
is  first  an  exceedinjTly  bad  here<lity  back-pround,  and  we  are 
told  of  a  mother  fairly  bright  (getting  "good  mark>'"  in 
school)  till  adolescence  and  then  failing.  Then  there  is  ver\' 
defective  vision.  And  while  this  does  account  for  some  >! 
the  pedagogical  retardation,  the  visual  defect  is  based  on 
deep-seated  disease  and  will  confiiiiic  to  be  a  retarding  fac- 
tor with  possible  blindness  as  an  outcome.  There  is  a  respir- 
atory system  already  weakened  by  re])eated  attacks,  and  a 
distinct  tendency  to  lung  involvement.  There  is  an  intelli- 
gence that  is  at  best  frail  and  distinclK-  lagging,  and  there 
is,  also,  an  evident  lack  of  self-assertion  and  self-direction. 
the  child  being  entirely  too  easy-going  and  dependent,  and 
giving  little  promise  of  being  able  to  face  the  world  for  her- 
self. ( )n  the  physical,  mental,  and  social  sides  it  seems  clear 
that  this  attractive  child,  little  retarded  as  she  appears  to  be, 
will  long  l)e  in  need  of  kindly  directi\-e  control  bv  an  insti- 
tution or  other  social  agent.  Her  men.lal  develo])ment  will 
hardly  contiime  very  much  further  and  her  dangers  will 
increase  man\'  fold. 


CASE  27. —  Dull 
and  Lazy.  Steady-go- 
ing, but  Lacking  in 
Mental  Resources. 
Chorea  with  Heart 
Trouble. 


128  BACKWARD  AND  FEEBLE-MINDED  CHILDREN. 

Delia  //.,  ^gc  F  Iff  ecu  and  One-half  Years. 

Delia  impresses  one  with  her  placid  countenance  in  spite 
of  its  occasional  choreic  movements.  A  Chicago  girl  ad- 
mitted in  August,   1909,  she  has  a  history  of  having  been 

picked  up  as  a  foundling,  and 
was  reared  by  a  city  family. 
Nothing  is  known  of  her  own 
family.  Tlie  child  had  nervous 
twitchings  from  infancy,  and 
this  was  assigned  as  a  cause  of 
mental  deficiency.  She  became 
addicted  to  self-abuse,  and  was 
notably  lazy  and  gluttonous,  would  hide  and  destroy  things, 
and  would  "run  awa}'  from  school  and  lie  about  it."  Four 
years  before  coming  to  Lincoln  she  "lost  the  use  of  her  limbs 
for  a  while,  but  recovered."  She  had  measles,  scarlet  fever, 
and  an  operation  for  tonsil itis,  but  was  generally  considered 
to  be  healthy. 

Physical  examination  shows  her  to  be  nearly  23  pounds 
above  in  weight  and  slightly  above  in  height.  Her  head  is 
36  mms.  below  in  circumference,  being  more  deficient  in 
length  than  in  breadth.  She  tests  well  above  on  the  spirom- 
eter, and  in  strength  of  grip  is  normal  ^vith  the  right  hand 
and  disproportionately  strong  with  the  left.  Her  vision  and 
hearing  are  normal.  The  ]ialate  is  narrow  and  high,  the  lips 
are  deeply  creased  vertically,  the  teeth  are  a  little  separated 
and  not  very  well  developed,  the  right  ear  has  the  Darwin- 
ian tubercle  prominent.  The  shoulders  are  of  unequal 
height  and  the  bodily  carriage  and  walk  are  slovenly. 

Medical  examination  records  a  jerky  and  irregular  respira- 
tion and  a  condition  of  the  lungs  that  is  otherwise  not  wholly 
satisfactory.  The  heart  is  enlarged  and  she  has  mitral 
regurgitation  and  chorea.     Menstruation  is  irregular. 


ci.iiNicAi.  .srL'i)ii;s  oi'  i:()I<1)i:k  casks.  ij<) 

Delia  reads  satisfacturiK  in  thr  fimrth  reader  and  dues 
verv  simple  i)r()l)leni!-  in  di\isi(in.  Slie  can  draw  siin])lc 
dcsiii'ns  inv  C"hristnia>  cards,  hnl  i>  sl()\-enl_\-  in  cla_\  niodelini^', 
laz\-  in  industrial  work  and  calisthenics,  and  awkward  in 
dancint;'.  her  clmrea  seeniin-;  to  interfere  with  the  latter. 
llowcNcr.  I  ha\e  seen  the  choreic  movements  disa])i>ear 
completely  as  she  ])layed  the  violin,  tho  tliex  usnall\  hecome 
more  violent  when  slie  makes  an  elTort.  I  ler  \iolin  teacher 
thinks  that  her  "nervousness"  does  not  interfere  with  her 
music,  hut  that  she  is  laz\  ,  tho  a  rather  satisfactory 
])U])il,  ne\ertheless.  She  studies  elementarx  history,  ])h\siol- 
oi^\',  and  s;eo.i;raph\-,  and  learns  these  lessons  rather  (|uickly. 

The  r.inet  tests  j^ive  Delia  a  mental  a^'e  of  i  i  '  _.  years, 
with  a  retardation  of  3' 2  xears.  1  U-r  speech  is  n<irmal. 
She  could  not  rei)resent  to  herself  social  situations  sui^jL^ested 
h\  the  tests,  antl  could  do  little  with  ahstractions.  "Jiistwr 
is  to  do  ri^ht.  Ain't  jiishd-  frccddin  too:"  di'odiu'ss  is 
"When  \(iu're  j^-ood."  (  'harU\  was  unknown.  .She  <loes 
not  met  e.xcited  and  does  not  show  an\-  s])ccial  tendenc)-  to 
confusion,  'i'o  the  limit  of  her  resources  she  kejit  adapted, 
but  the  resources  were  not  extensive.  'I  he  choreic  mo\e- 
ments  did  not  seem  aggravated  by  the  tests.  In  actual  tlhnk- 
ing  the\-  sometimes  ceased,  or  were  i)artially  rejilaced  h\- 
bulging  of  the  forehead  muscles,  etc. 

The  written  tests  show  legible  but  childdike  handwriting. 
( )ccasionall>-  there  is  ver\  bad  use  of  cajjitals,  marks,  and 
paragraphs,  and  some  bad  spelling.  I'suall}'  her  comi)osition 
shows  smootli  and  grammatical  luiglish.  Imagination  was 
but  little  in  evidence,  and  her  Hying-machine  tri])  showed 
her  onlv  some  children  skating,  snow-balling,  and  coasting. 
and  ])eoi)le  taking  children  out  on   sleds. 

Delia  makes  a  nearly-  perfect  record  in  the  tests  for  asso- 


130  i;ackvvaki)  and  fkeule- minded  children. 

ciation  by  similars  and  opposites,  and  she  crossed  87  and 
then  TOO  A's  with  but  one  partial  error,  in  tests  of  2  minutes 
each. 

Taking-  all  the  data  together  we  find  prognosis  difficidt 
from  the  lack  of  knowledge  about  the  child's  heredity  and 
development.  The  ap])arent  paralysis  of  five  years  ago  is 
suggestive  of  trouble  later,  but  may  be  incorrectly  reported. 
The  chorea,  heart  lesion,  and  weak  lungs  mark  her  as  a  girl 
that  will  always  need  medical  attention.  The  laziness  seems 
to  be  constitutional,  perhaps  part  and  parcel  with  the  phys- 
ical condition.  She  has  such  a  ]:)aucity  of  mental  resources 
as  makes  her  one  of  the  mildl\-  dull  feeble-minded.  (Jn  the 
other  hand  her  emotional  steadiness  and  rather  equable  dis- 
position make  of  her  a  girl  who,  with  wise  parental  control 
and  some  careful  attention  to  her  bad  sex  habits,  might 
ordinarily  fit  fairly  well  into  home  conditions.  Such  adjust- 
ment will  not  be  wise  until  society  renders  impossible  mar- 
riage or  at  least  the  bearing  of  children  by  such  defectives. 
For  the  present  Delia  should  be  trained  to  useful  activities 
in  the  institution. 


ci.ixicAL  srui)]i:s  (M-  ikikhkr  casks. 


Mf 


U'ciuiy  J..  .  / i^'('  7'Tk't'/;/v  Years. 


CASE  28.  —  Dull, 
with  Occasional  Out- 
breaks. Excels  in 
Lace  -  Making  and 
House-Work. 


Wendy,  iiiiw  a  rather  ]jr(.'ll_\-  j^irl  of  20.  came  to  tlie  insti- 
tution   11    \cars  a.^o.      Xotliini;-  is   known   0I    lu'r   famih-   or 
])ers()nal  liislor\'  except  that  when  aihnitted  there  were  stated 
to   he   two   l)rothers   and   a    sister 
ah\-e  and  nientah_\-  ><  nmd. 

I 'li_\sicail_\'  she  is  nearly  four 
pounds  aho\e  in  wei.^iit  and  1.3 
inches  helow  in  height,  with  a 
cranial  circumference  that  is  24 
mms.  lielow  normal  and  a  cranial 
len!:>tli  that  is  K)  mms.  below.  The 

chin  is  receding"  and  the  thyroid  is  somewhat  enlarged,  lint 
there  is  nothing-  else  worthy  of  note  and  her  physical  health 
is  considered  good. 

In  school  Wendy  reads  with  fair  tluenc\-  an\-  reading  mat- 
ter that  is  comparatively  simple.  She  does  <»nl_\-  the  very 
simplest  addition  and  subtraction,  almost  always  failing  in 
multiplication  and  she  is  quite  unable  to  divide.  I  ler  music 
is  like  her  arithmetic,  she  sim])ly  carniot  learn  it.  After  ])rac- 
ticing  for  months  at  an  eas\-  violin  selection,  a  sim])lest  be- 
ginner's series  of  measures,  and  having  lessons  all  this  time, 
she  was  still  (|uite  una1)le  to  play  it.  It  is  in  the  manual  room 
that  Wendv  excels.  Here  she  makes  beautiful  lace  with  the 
lace  machine.  She  is  a  little  slow  but  is  ver}'  neat  and  satis- 
factory in  this  work,  always  leaves  the  bobl)ins  arranged 
"inst  so,"  and  seems  contented  here.  The  girls  in  the  man- 
ual room  are  said  to  "look  u])  to  her  a  good  deal."  She  usu- 
allv  attends  as  well  as  normal  children  and  gets  on  well  with 
the  girls  and  with  her  teachers.  exce])t  for  an  occasional  out- 
break of  stubborn  resistance. 

Mentally  Wendy  shows  an  intelligence  age  of  to/j  years, 
a  retardation  of  ()]/>  years.     She  could  not  debne  or  distin- 


132 


P.ACKWAKD    AND   FEEBLE-MINDED  CHILDREN. 


guish  terms,  coukl  not  make  change  or  arrange  weights,  and 
conld  not  detect  the  nonsense  in  silly  statements.  She  was 
shv  and  timid,  with  an  unreadiness  to  undertake  and  a  tend- 
ency to  give  up  that  is  characteristic  of  the  typically  dull 
children.     There  was,  too,  the  typical  scantiness  of  mental 

resources,  and  there  were  no 
reacticMis  that  showed  any 
sfrciij^t'i  of  intelligence,  but 
rather  the  tendency  to  win 
with  a  smile  a  way  around 
the  ])rohlems  that  needed 
mental  grip  for  their  solu- 
tion. Abstractions  were 
meaningless,  and  the  ordi- 
nary grade  work  of  a  school 
would  be  for  this  girl  a  per- 
petual monotony  and  waste 
of  time. 

The  written  tests  show  a 
handwriting  that  is  very  leg- 
ible, though  somewhat  irreg- 
ular and  undeveloped.  Capi- 
tals and  inmctuation  marks 
are  usualh'  omitted.  She  for- 
gets some  needed  Vi'ords  and 
loses  track  of  what  precedes 
as  she  writes  further,  though 
apparently  her  inner  speech 
was  all  the  time  proceeding 
in  normal  sequences.  Her 
story  reproductions  are  extremely  simplified,  sketchy  state- 
ments, omitting  most  of  what  should  be  given.  Of  ''The 
.Straw.  Coal,  and  liean"  she  writes:  'Tn  the  vill  live  a  lady 
one  day  she  out  to  the  garden  to  pict  some  beans  for  dinner 


WENDY    (t. 


CLiXICA!    STI/IMI'.S  (tl-"   1;()i^1;I;k  ('AS1-:S.  1  33 

the  starw  sli])  nut  of  licr  tiiij^crs  and  frld  to  llie  floor  She  put 
the  beans  in  lli;'  pot  one  of  the  hcan  saifl  it  hickiuL;'  I  feld  I 
would  liave  been  cook  to  deatli  if  she-  i»nl  in  with  rest  of  them 
])retty  soon  a  tarlor  come  and  ^a\\  what  a  poor  fi\  liir  bean 
in." 

tier  out])ut  in  the  tests  •^■(.-nerally  is  ver\-  niea'4'er.  tlioui;!)  a 
]:)erformanct'  which  could  he  reduced  to  automatism,  .-ucli  as 
the  A-test,  could  soon  he  fairl\-  well  done. 

I  have  spoken  ot  W  end_\"s  occasional  ohstinacw  At  rare 
intervals  this  has  manifested  itself  a>  downright  vieit)nsness, 
as  when  with  two  other  ^irls  she  delihcrateh-  ]ilanne(l  to  .cive 
a  third  i^irl  a  j^ood  kicking-,  and  hrutalK'  carried  it  out.  A  dull 
mind  is  not  by  that  fact  a  harmless  mind,  and  outbreaks  like 
the  above  are  much  less  ex])ensively  adjudicated  in  an  insti- 
tution than  in  o])en  societ)-.  ddiose  who  have  lon^-  had  chari^^e 
of  Wendy  say  she  woidd  never  be  able  to  Ii\e  safel\-  ontsicK'. 
And  _\-et  only  recently  an  etiort  was  made  to  remove  her,  b\- 
some  one,  it  is  stated  at  the  institution,  who  i>  not  herself 
of  over-strong'  mentalitv. 

(  )n  the  other  hand  Wendy  has  won  a  reputation  for  neat 
bed-making  and  other  work  on  the  ward,  and  the  success 
with  which  she  has  learned  to  do  woman's  hand  work  and 
housekeeping  duties,  with  the  contentment  and  right  ideals 
that  she  is  showing  in  these  tasks,  suggests  where  the  em- 
phasis shotild  be  ]ilaced  in   training   these  dull   girls. 


134 


I'.ACKW  AKU   AND  FKEBLE-MIXDED  CHILDREN. 


Cas/^cr  H.,  Ai^c  Thirfccii  or  Fourteen  Years. 


CASE  29.  — Dull 
and  Infantile.  Weak 
Heredity.  Defective 
Motor  and  Emotional 
Control. 


Casper  is  still  another  of  the  dull  children  who  have  little 
mental  or  moral  coloring".  The  admission  data  are  meager 
and  do  not  state  his  age.    Me  has  been  in  the  institution  since 

1902.  and  was  evidently  as  much 
as  six  years  of  age  when  admit- 
ted, according'  to  the  statements 
of  those  who  knew  him  then.  His 
mother  is  said  to  have  been  men- 
tally defective  and  "stupid  as  a 
worker."  and  the  family  was  de- 
pendent, the  boy  being  cared  for 
in  one  of  Chicago's  charitable  institutions. 

Casper  is  slightly  above  in  weight  and  below  in  height. 
with  a  head  that  is  a  trifle  larger  and  longer  than  the  normal 
average.  His  performance  with  the  spirometer  and  dyna- 
mometer is  not  quite  up  to  par  l)ut  he  is  disproporticniately 
strong  with  the  left  hand.  He  has  but  two-thirds  vision  with 
the  right  eye  and  two-fifths  with  the  left.  His  hearing  is 
normal. 

His  upper  incisors  are  separate  but  the  teeth  are  fairly 
regular  and  good.  The  uvula  is  small  and  the  palate  rather 
high.  The  ears  have  large  Darwinian  tubercles.  I'here  is 
a  general  unbalance  and  lack  of  tone  in  the  bodily  carriage. 
In  school  Casper  gives  no  trouble  on  the  side  of  discipline 
or  morals,  and  gets  on  well  with  the  other  children.  He  is 
docile  and  especially  amiable,  a  general  favorite  with  his 
teachers,  whom  he  assists  in  a  variety  of  wa}s.  However, 
he  attends  badly,  is  very  distractible,  and  his  "worst  fault" 
is  stated  to  be  laziness  and  great  restlessness.  He  sometimes 
"says  little  silly  things"  and  is  quite  "babyish."  He  reads 
fairly  in  the  third  reader,  spells  well  such  words  as  occur  in 
his  reader,  and  is  one  of  the  three  best  in  his  class  in  simple 


c'l.ixK  Ai.  sifDii'.s  oi'  i!()ia)i;K  iAsi-;s.  J35 

<lra\\iii<4  work.  I  \c  iiumas^X'^  Id  work  xuiic  ])riil)lcm^  in  loiit;' 
(li\'iMiiii,  l)iil  nc\'L'i"llu'le'^s  rDuld  not  dix'iiK'  loi'U'  1)\'  six  or 
twenty  by  four,  wlnn  le-^lcik  In  Dlhcr  school  work  he  shows 
no  s])ecial  al)iHt\'  or  deticieney.  I  fear  that  much  of  his  learn- 
ini^'  is  rather  wooden.  When  asked  to  read  or<linaril\  eas\- 
matter  not  tound  in  the  readers  he  eonkl  not  ])r()nounce 
course,  z'aru'd.  provided,  ronsisis,  conrciiiciit .  members,  iif- 
taehed.  etc.,  and  needed  constant  assistance  to  ^et  throni;h 
at  all.  Asked  what  is  the  capital  of  Indiana  he  answered 
"Minnesota."    Asked  what  \ear  this  is  he  answers  "AN'inter." 

L'asper  i)la_\'s  second  clarionet  in  the  band,  reads  the  music 
readily,  plays  well  and  learns  selections  with  normal  rapid- 
ity; but  his  musical  ability  is  "below  normal,"  and  he  lacks 
attention  and  is  very  distractil)le  here  as  elsewhere. 

The  mental  examination  shows  an  intellij^'ence  age  of  nine 
and  a  half  }ears,  with  a  retardation  of  as  much  as  three  and 
more  probably  of  four  years.  J  lis  sjteech  shows  such  errors 
of  articttlation  as  irick  for  creek,  free  for  three,  de  for  the. 
and  some  others,  with  yer\    incorrect   i'Ji,<.;iish  hi  general. 

The  written  tests  show  a  handwritinL^'  that  is  infantile  and 
irregular.  l)ut  that  can  be  read.  The  lines  are  at  all  angles, 
with  no  cai)itals  or  i)unctuation  marks.  Some  of  his  numer- 
ous mis-spellings  are  a  ])on  (  u])on  ),  sone  (  some),  an  (  and  ). 
Hore  (floor),  coa  (coal),  where  (were),  watch  (which), 
brig  (  bridg'e  ) ,  acrose  (  across  ) ,  taler  ( tailor  ) ,  svede  1  sewed  ) , 
warl  (worUn,  enft  (enongh),  slaj  (sleigh),  iitying  (fight- 
ing), settch  (statue),  dad  (day),  sed  (said),  women 
(  warm  ),  maber  (  marl)le). 

lie  omits  whole  ])hrases  that  ap])arentl\-  were  more  or  less 
present  in  his  thought,  as  in  the  following  exam])les;  "(  )nce 
a  pon  (a  time)  an  old  lad\- ;"  "She  was  ])utling  ( l)eans  in  a 
pot  when)  a  straw  fell;"  "(  )nce  a  (  artist  )  works  for  _\ears  ;" 
"Every  bean  had  scar  on  them." 

His  output  is  yer\-   meager   for   all   the   written   tests  and 


136  BACKWARD  AND  FEEBLE-MINDED  CHILDREN. 

he  shows  a  paucity  of  mental  resources  and  a  shiggish  move- 
ment of  tliought.  He  could  do  fairly  well  in  the  orientation 
tests,  hut  seemed  too  inexpressibly  lazy  and  lacking  in  tone 
and  energy  to  make  more  than  the  most  necessary  move- 
ments. His  tapping  rate  was  sixteen  below  with  the  right 
hand  and  twenty-nine  below  with  the  left.  He  alternated 
between  a  lazy  tapping  with  a  single  finger,  against  which 
he  had  to  be  cautioned  repeatedly,  and  a  hammering  method 
which  several  times  deranged  the  instrument. 

(ieneral  observation  shows  Casper  to  be  shy  and  un-aggres- 
sive,  with  a  tendency  to  take  refuge  in  infantile  reactions, 
lie  has  doubtless  been  "babied"  a  great  deal,  and  does  not 
seem  to  have  thought  of  taking  any  other  attitude.  He  cries 
readily  when  reproved,  sits  or  walks  with  little  tone  in  his 
carriage,  and  shows  a  constantly'  recurring  shift  and  s(|uirm 
of  bodily  and  facial  position  and  expression,  causing  various 
observers  to  call  him  restless,  babyish,  shy.  nervous,  unstable, 
etc.  vSome  of  this  is  merely  bad  habit.  More  of  it'  seems  to 
be  the  manifestations  of  a  nervous  system  that  has  not  grown 
to  normal  strength  and  stability  and  that  gives  him  an  un- 
toned  carriage,  a  weak-willed,  lazy  attitude,  and  a  mentality 
that  would  answer  for  a  much  younger  boy,  that  has  even 
been  thought  normal  by  some  wh(^  have  known  him,  but  that 
has  lagge<l  well  behind  his  vears. 


Cl.IN'ICAI.  STn)Il'".S  <)l"   l!<)RI)!".R  C'ASI'.S. 


Saiiiiicl  ./.,  .  /,^('  7\ii  yciir. 


CASE 

30.   - 

-   E  n- 

larged    Thyroi 

d    with 

Exophtha 

m  0  s  . 

Dreamer 

and 

Joker, 

who    m  a 

kes 

Little 

Progress 

in  School. 

This  is  a  curious  and  interesting'  case  which  could  liave 
Init  httlc  stud}'  as  the  child  was  early  taken  to  his  home.  Ad- 
mitted in  igoi),  Samuel's  t'amily  would  srem  to  he  healthy. 
They  are  of  I'olish,  nationalitx'. 
Samuel  was  "peculiar  from 
hirth,"  had  one  con\;ulsion  at 
three  \ears  of  a.^e,  did  not  he^in 
to  talk  till  his  fourth  \ear  and 
was  late  in  i^-ettin.L;'  his  teeth.  1  le 
did  not  learn  to  dress  and  un<lress 
or  to  tie  a  shoe-lace,  and  he  "ran 
avvav  every  chance  he  .t^nt."  lie  showed  an  earl\'  tendency 
to  play  jokes,  as  when  he  is  said  to  have  clini1)e(l  on  the  roof 
and  stopj)ed  l)otli  chimnexs.  Me  was  sent  to  school  "several 
times  but  always  ran  away.'" 

I'hysicalh'  Samuel  is  considerably  below  normal  in  weight 
and  heig-ht,  and  is  moderatel}'  deticient  in  streniLith  ot  i^rip. 
I  lis  head  is  of  about  normal  size  but  shows  some  as_\'mmetr_\'. 
The  teeth  are  notched  and  the  l)ack  teeth  are  mostI\'  absent. 
The  mouth  is  small,  palate  hi.uh.  eyes  exo])hthaImic.  ears 
laru:e  with  Darwinian  tubercle  i)rominent  in  the  Kit.  There 
is  marked  tremor  of  the  toui^ue  and  the  hands  take  abnormal 
positions  on  extension.  The  skin  is  pale  and  the  muscles  and 
i>enitaLs  are  not  v.ell  developed.  \'ision  is  but  one-halt  in 
either  eye  and  his  hearing  is  slightly  defective  on  both  sides. 

Medical  examination  shows  enlarged  thxroid.  with  exoph- 
thalmos and  marked  irregularity  of  pulse  rhylhni.  There  is 
some  cvanosis  of  the  linger  tijis  and  the  heart-sounds  are  ni»t 
normal. 

In  school  Samuel  has  never  learned  to  read,  sjiell,  u.se  num- 
bers, or  draw.  Me  is  not  neat  in  kindergarten  work-  and 
"dreams"  to  much  \o  do  well  in  calisthenics.     Me  attends  to 


138  liACKWAKl)    AXI)    FEEIJLE-MINDKi)   CIIH.DRKN. 

his  teacher  but  seldom  tn  his  task.  Me  gets  on  well  with  the 
otiier  children  and  his  worst  fault  is  stated  to  he  his  "dreami- 
ness". 

The  Binet  examination  skives  Samuel  a  mental  age  of 
seven  years,  with  a  retardation  of  three  vears.  He  could  not 
tell  which  was  his  right  hand,  did  not  know  his  age,  could 
not  copy  a  diamond  shape  nor  give  correctly  two  details  of 
a  news  item  read  to  him.  He  was  unable  to  count  stamps, 
or  backwards  from  twenty.  He  makes  infantile  expressions, 
as  when  he  said,  "Rags  can't  tore,  have  to  cut  "em,"  and 
"You  can't  tore  rag's."  His  articulation  is  somewhat  defec- 
tive. 

He  could  not  be  taught  to  use  the  spirometer,  because  of 
his  "fooling"  and  his  ignorance  together.  Then  he  sat  down 
with  me  and  suddenly  broke  out  with  a  vivid  description  of 
his  mother  cooking  nice  pork  and  cabl)age,  at  home,  and  of 
the  nice  lire  there  with  lots  of  coal ;  and  his  eyes  brightened 
and  he  grew  intelligently  enthusiastic  about  these  home 
scenes.  This  was  all  done,  however,  in  a  quiet,  dreamy  sort 
of  way.  In  school  he  sits  "dreaming"  instead  of  working". 
I  note  that  he  watches  me  with  interest  when  he  thinks  he 
is  unnoticed.  He  seems  to  see  the  fun  that  there  is  in  things, 
in  his  simple  way,  but  he  does  not  have  normal  control  of  his 
laughter. 

In  this  case  of  mental  and  physical  retardation  associated 
with  thyroid  mis-functioning  we  find  some  interesting  svni])- 
toms  and  trails  (|uite  other  than  those  of  the  ordinarv  dull 
child.  It  is  to  be  ho])ed  that  Samuel  mav  come  urider  further 
observation. 


11  i\n  Ai.  SI  L'Dii.s  ill'  i;i)|<|)i;k  casms. 


139 


KcJiii.'lli  M ..  .  I '^c  StZ'cnlci'ii    ]'cars. 


CASE  31..  — .Dull 
and  Infantile.  Dwarf- 
ed Physically  and 
Mentally.  Premature 
Senescence. 


Kenneth  is  a  liltlc  i'iili>li  dwarf  who  has  l^cen  at  the  insti- 
tution since   Marcli.   i<;()i).     As  lie  sils  at  his  desk  in   school 
he  would  he  mistaken  for  a  l)o\"  ot  nine  years.     ( )nldoors  his 
peculiar  walk,  his  wrinkled,  wiz- 
ened face  and  "old"  maniier,  yive 
him  the  aj^pearance  of  a  little  old 
man. 

His  father  is  hrit  sli^hll}'  over 
five  feet  in  height  and  the  mother 
is  still  shorter.  'idie\'  are  sim])le, 
mild-mannered     "])easant"'     folk, 

and  appear  to  he  healthy,  as  does  KennethV  brother,  an  ap- 
parentlv  intelli.'i^ent  ho}'.  Kenneth  weiii'lied  but  four  ])ounds  at 
birth  and  was  ill  most  of  the  time  till  his  tenth  \ear.  1  le  "did 
not  grow,"  did  not  Ix-.^in  to  talk  until  his  fourth  year,  and  had 
diphtheria  severely  at  five  years.  At  seven  years  his  mental 
peculiaritv  was  first  noted  in  his  lack  of  memory  and  of  com- 
prehension. I  le  spent  aliout  seven  years  in  school,  with  little 
progress. 

P'hysically  the  boy  weighs  but  forty-nine  j^ounds  and  is 
three  feet  eight  and  a  half  inches  tall,  llis  head  i>  twenty- 
eight  mms.  below  the  normal  in  girth  and  twenty-one  mms. 
below  in  length.  l)ut  exceeds  the  normal  breadth  l)y  seven 
mms.  His  strength  of  grip  and  lung  capacity  are  those  of  a 
small  child,  and  his  rate  of  tapping  is  ])roportionately  slow. 
His  vision  is  defective  in  both  eyes,  his  hearing  is  normal. 

He  has  a  very  broad  face,  small  mouth,  irregular  lower 
jaw  and  a  uvula  that  is  diminutive  or  wanting,  llis  eyes 
are  widely  separate  and  seem  small,  probably  the  jnUpebral 
fissure  is  short.  The  skin  is  somewhat  wrinkled  and  leath- 
ery. He  is  pot-bellied,  the  genitals  are  abnormal!}-  small,  and 
there  is  a  small  riiiht  inL;uinal  hernia. 


140 


r.ACKWAKI)   AND   FEKBLE-.M  I  XDKD  CIIILDRKM. 


Ill  school  Kenneth  reads  fairly  in  the  third  reader,  adds 
and  subtracts,  and  in  other  subjects  does  about  the  work  of  a 


KKXXIOTII    M.    AXI»    rKTKU    A. 

ten-year-old  boy.  He  attends  well,  t^ets  on  well  with  others, 
and  is  not  credited  with  haviui;-  anv  "faults".  Every  one 
notes  his  bashfulness.  He  plays  second  cornet  in  the  insti- 
tution band  and  his  instructor  states  that  in  nine  months' 
work  he  has  only  fallen  about  one  month  behind  the  normal 
proi^ress,  but  that  he  is  slii^htK-  below  normal  in  nuisical 
ability. 

In  the  r.inet  examination  Kenneth  earns  a  niental  age  of 
nine  with  a  retardation  of  seven  and  a  half  years.  He  was 
interminably  slow  and  hesitant  in  his  reactions,  and  infantile 
in  his  speech  and  manner.  His  responses  are  weak,  with  lit- 
tle spontaneity  or  self-assertion.     He  is  extremely  sensitive, 


CL1\](.'.\[,  STI'DIKS  ()!•■    I1<)1<1)1-:K   CASKS.  I4I 

and  is  al)(>ut  as  trail  inciilall)  as  he  is  iiisi.L;iiiru-aiil  Inxlily. 
I  lis  mcMilal  ways  as  well  as  lii>  a|)i)c'arance'  and  walk  inii)rcss 
me  as  do  those  of  a  feehle  old  man  who  is  not  very  snre  of 
himself  in  anything;. 

Idle  attempts  at  stor\-  rej)rodnetion  and  invention  and  at 
giving"  opposites  and  similar^  show  the  same  feebleness  of 
]ierf()rmance.  He  writes  (|nite  as  a  little  child  draws,  giving 
onl\-  some  main  lines  of  his  thought  with  glaring  omissions 
as  viewed  from  an\-  logical  stand])oint,  just  as  in  children's 
drawings.  Wdiat  he  writes  is  hut  a  sketching  (i^cmn f^niiiiitciit 
to  his  thonght,  sim])lified  to  the  last  degree,  bnt  suggesting 
after  all  that  his  tluuti!^ht  has  had  a  natural  se(|uence.  In- 
deed the  latter  is  the  case  more  often  than  would  api)ear  from 
liastx  glances  at  these  children's  compositions. 

1  lis  spelling  is  fantastic.  l^xam])les  are  zcaiiDn  for  zcoiiian. 
lojj;catcr  for  foi^^ctlnv,  -wcMiT  for  rcfz/rr,  stares  for  sfatiir.  chal 
for  chcclcs.  bL\:^crt  f<ir  lh\ij,iiii.  chidrcu  for  children,  a^^riif  for 
(/i;(////.  -cehciif  for  went,  lie  uses  few  ca])itals  or  i)unctuation 
marks,  and  these  are  mis-placed. 

Further  interpretation  of  this  as  of  man_\-  of  ihe  other 
cases  is  advisedlv  postponed  to  a  later  time.  We  need  to 
have  many  careful  studies  of  similar  cases,  and  the  observa- 
tions should  be  continued  through  a  term  of  \ears.  \\  hat  is 
the  natural  life  cycle  of  such  a  child  as  this?  Wdiat  of  the 
manv  lives  that  seem  1)orn  to  run  a  brief  and  "telescoi)ed" 
course,  physically  and  mentall\-,  amounting  even  to  juvenile 
senescence?  What  of  the  ■"going  back"  so  often  reported 
in  the  institutions  and  not  always  a  matter  of  epile])tic  de- 
terioration? We  shall  ho]:)e  that  the  life-courses  of  topical 
cases  will  be  studied  and  followed  with  care,  for  it  is  only 
from  such  bases  thai  valid  conclusions  are  to  be  drawn. 


CASE  32.  —  Dull 
and  Infantile.  Thiev- 
ing and  Lying,  but 
without   Malice. 


142  UACKWAKD   AND   FKI':i!LE-AI  I  ND1£D  CHILDKKN. 

Frit:::  .i.,  Ai^c  Tivclvc  Years. 

I^'ritz  is  a  slender,  dark-eyed  boy  who  meets  you  with  a 
])ecuHar,  fixed  gaze  that  seems  to  express  the  deepest  interest, 
but  is  probably  rather  of  the  nature  of  an  automatism.     He 

belongs  to  the  dull  group ;  but 
his  voice  for  singing,  his  interest 
in  hearing  and  re-telling  stories, 
and  his  petty  thieving  tend  to 
give  color  to  the  case. 

He  has  been  in  the  institution 
for  two  years,  coming  from  Chi- 
cago. His  heredity  seems  to  be  very  fair  but  he  is  stated  to 
be  the  seventeenth  child,  twelve  of  the  children  being  "dead 
babies."  h'ritz  was  born  prematurely  at  seven  months  and  is 
said  to  have  weighed  but  two  pounds!  He  was  always  deli- 
cate and  backward  in  growth  and  did  not  begin  to  talk  until 
he  was  two  years  of  age. 

He  is  more  than  four  pounds  above  in  weight  and  one  and 
three-tenths  inches  above  in  height,  liis  head  is  nineteen 
mms.  too  small  in  circumference,  the  deficiency  being  mainl\- 
in  breadth.  His  spirometer  test  is  a  little  above  the  normal, 
and  in  strength  of  grip  he  is  not  far  from  normal  luit  is  dis- 
proportionately strong  with  the  left  hand.  His  vision  and 
hearing  are  normal. 

The  u]iper  teeth  are  separate  and  notched,  but  in  fair  con- 
dition. Idle  uvula  and  soft  ])alate  are  defective.  The  nails 
are  unusually  short.  The  bodily  attitudes  taken  suggest  lord- 
osis. Medical  examination  adds  only  that  his  peripheral  cir- 
culation is  not  very  good. 

In  school  Fritz  reads  pretty  well  in  the  first  reader,  adds 
and  subtracts  a  little,  and  has  reached  his  fifth  table.  His 
teacher  is  well  satisfied  with  the  simple  work  that  he  attempts 
in  spelling,  drawing,  manual  work  and  calisthenics.    He  is  a 


c'l.iNicAr.  .s'i"iiui:s  oi-'  isoudkr  (.asks. 


143 


j4i)(i(l  (lam'iT,  "alleluia"  well,  and  is  oiil}-  Irouhk-Mimc  hy  his 
])ctt\'  lhic\in,L;.  which  he  "lies  ()iit  iit"  when  jxissihle.  Ili> 
attendant  rejjorts  that  he  is  ""kind  uf  Niicakini;  '  and  tliat  he 
■'steals  a  lot.""  I  le  assists  in  the  entertainments,  sint^in^'  witli 
a  rather  sweet  voice  :  and  he  aiun>t-s  1)\  lellini^  stories  of  what 
he  sees  in  the  instittition's  ])icture-show--.  Mis  tales,  how- 
ever, do  not  hear  N'crification  ver_\-  well. 
Mentally  i'rilz  tests  to  the  level  of 
seven  and  a  half  \ears  with  a  retarda- 
tion of  three  and  a  half  \ears.  Mis 
speech  is  sliuhth'  defective.  Me 
worked  tweh'e  nnnntes  tr\in'^'  to  i)Ut 
to.^ether  a.^ain  the  two  pieces  of  a 
rectani;nlar  card  that  had  l)cen  cut 
diagonally  and  separated,  and  he  fail 
in  the  end.  fie  frecjnenth-  made  in- 
congruous and  rather  silk'  replies,  an- 
swering "tw'ent\-fonr""  when  asked 
how  many  lingers  on  hoth  hands,  an- 
swering "Saturdax-"'  when  asked  to 
give  the  year,  and  sa\ing  "twentx'- 
two"  for  "foiu""  when  comiting  hy 
twos.  "Take  my  picture  taken  Satur- 
day" was  his  suhstitute  for  "lake  m\- 
picture  Saturda}.""  (  )n  another  occa- 
sion in  telling  of  a  strav  dog  he  said 
"Mis  name's  C'harlie  l^'rancis.  we  call 
him  a  dog.'"  1  )tu"ing  the  testing  he 
(lived   into  drawers  and  cases  in   s])ite 

of  commands  to  let  things  lie,  and  teachers  sa\'  that  he  doe> 
this  in  school  and  that  he  steals  "right  and  left."'  Me  did 
not  steal  in  this  lahoratory-rummaging,  but  seemed  to  rum- 
mage as  a  sort  of  automatic  necessit}-,  mixed  with  some  cu- 
riositv. 


I'KII/    A. 


144  BACKWARD   AND  FEEBLE-MINDED  CIIII.DRKX. 

His  tendency  to  automatism  aj^peared  in  his  association 
reactions,  twenty-one  in  the  one  hundred  trials  being  made 
in  exactly  his  median  time  of  two  seconds.  Sixty-six  times 
he  reacted  with  jjhrases  or  sentences,  all  but  two  being  of 
the  nature  of  tlehnitions.  His  associations  are  very  simple, 
rather  ])uerile  and  naive  throughdut.  but  they  are  nearly  all 
naturally  related  to  the  stimulus,  not  senseless  or  bizarre. 

bVitz  writes  legibly,  but  utterly  failed  to  use  writing  in  the 
tests  that  rec|uired  it.  When  permitted  to  re]iroduce  one  of 
the  stories  orally  he  told  a  pleasingly  Huent  story,  short  and 
in  the  manner  of  a  young  child,  and  not  very  correct,  but 
with  a  sim])le  harmony  of  ideas  that  hid  the  actual  confusion 
of  memory. 

He  merely  copied  the  ojiposite  and  similar  lists.  When 
asked  to  arrange  the  i)hot()gra])hs  of  our  buildings  as  they 
stand  he  placed  them  in  two  straight  ])arallel  lines  along  one 
edge  of  the  table.  He  steadily  and  ra])idly  increased  his 
speed  of  crossing  A's  and  of  placing  the  form  board  blocks, 
from  ver}-  weak  beginnings.  The  tendency  to  automatism 
here  has  a  chance  to  exercise  itself,  without  the  necessity  of 
much  real  learning. 

In  general  the  tests  and  observations  show  us  a  child  wdio 
is  dull  and  infantile,  with  few  ideas  and  these  confusing  eas- 
ily :  with  rummaging  and  ])ilfering  habits  that  are  little  re- 
moved frdui  the  un-moral  ways  of  a  \-ery  young  child  in  its 
relations  with  proi)erty  ;  with  a  general  feebleness  and  im- 
maturit}-  of  mental  ])erformance  that  seem  of  a  i)iece  with 
the  history  of  premature  birth  and  weakness  in  infancy  ;  all 
indicating  a  condition  of  congenital  defect  that  will  not  be 
outgrown.  He  can  be  made  useful  and  happy  under  perma- 
nent direction  in  some  well-chosen  industrial  occupation,  and 
in  an  environment  where  he  need  not  be  held  to  the  adult 
standards  as  to  relations  with  pro]:)ert}-  and  facts. 


cLJNJCAL  STUDiKS  oi'  i;oki)i:k  casks. 


145 


Vincent  (".,  ./.i,'<'  I'oiirtccn    )'car. 


CASE  33.— Dull, 
with  Special  Diffi- 
culty in  the  Use  of 
Language.  Physical 
Stigmata.  Thieving 
and  Untruthful.  Nor- 
mal Work  in  Music. 


\'incent.   anotlicr  of  our  dull    ])(>\s.  lias  liccn   here   since 
l<j04.     I  lis  niolhcr  was  hut  tiftc-cn  Ncars  old  at  Iun  hirtli.  and 
it  is  stated  th.at  she   was  epileptic.     The  hduie  record   ^ives 
little  more  e.\ce])t  that  it  seemed 
impossihle    for    the    child    to    re- 
memljcr.    and    that    he    was    un- 
truthful and  had  "a  tendency  to 
take    anything'   he    sees    whether 
of  value   of  not."     He  attended 
school  since  Ijecomin"'  of  scIkjoI 
age. 

Physically  \  incent  is  slighth' 
above  the  average  for  his  age  in  weight  and  height,  and  is 
sixteen  mms.  above  in  cranial  circumference,  ilis  lung  ca- 
pacity is  aj)i)roximately  normal,  but  he  is  somewhat  inferior 
in  strength  of  grij).  The  right  eye  has  but  two-thirds  vision, 
and  there  is  strabismus.  His  hearing  is  normal.  Ilis  head 
shows  some  asymmetrical  irregularity,  the  lower  li])  has  a 
deep  median  vertical  tissure,  the  upper  incisors  point  toward 
each  other  decidedly  and  are  a  little  separate  from  the  others, 
and  the  lower  middle  incisors  are  not  well  developed.  He 
has  a  diminutive  uvula,  short  nails,  and  stubl)y  fingers  that 
are  over-tai)ere(l  toward  the  ends.  I  le  has  not  had  a  medical 
examination,  but  aj^pears  to  have  good  health. 

In  school  X'incent  has  most  trouble  with  reading,  being  in 
the  second  reader  class  and  i)oor  at  that.  I  le  does  some  jjrob- 
lems  in  multi]ilication  and  division  and  is  re])orted  "satisfac- 
tory" in  spelling,  drawing,  industrial  work,  calisthenics,  and 
especially  in  band  work.  He  attends  well  in  certain  subiects 
and  badly  in  others,  the  personal  relation  with  the  teacher 
seeming  to  have  most  to  do  with  this.  He  ])lays  solo  horn 
in  the  institution   band,  is  an   "excellent   sight   reader"   with 


I4<J  i;ack\vakl)  and  feeble- :\iixded  ciiit.dkkx. 

"iiormal  musical  ability,"  and  from  Thursday  to  Sunday  will 
learn  a  new  selection  to  play  as  a  solo  for  the  chapel  serv- 
ice. On  the  other  hand  Vincent's  attendant  finds  him  to  be 
a  _qTeat  disappointment.  He  seemed  to  be  one  of  the  bright- 
est boys  when  he  came,  but  has  "turned  out  to  have  little 
sense,"  "not  so  much  as  he  had."  besides,  he  has  a  reputa- 
tion for  thieviuii'. 

The  mental  examination  gives  Vincent  an  intelligence  level 
of  ten  and  a  half  years,  a  retardation  of  three  years.  His 
speech  is  defective  for  certain  sounds.  His  reading  is  all 
but  impossible.  He  could  not  detect  the  nonsense  in  silly 
statements,  could  not  construct  sentences  which  would  use 
three  given  words,  etc.  He  tends  to  remain  silent,  giving 
up  the  task  if  it  is  difflcult.  He  shows  no  spontaneity,  has  to 
be  stirred  to  thinking  and  tends  to  lapse  into  a  condition  in 
which  he  seems  to  be  complacently  void  of  ideas. 

He  said  he  passed  through  several  ''countries"  on  his  way 
here,  but  could  not  name  any  town  that  he  passed.  He 
knew  the  name  of  his  home  town  but  had  no  idea  where  it 
was.  He  talks  in  a  very  confused  way  of  his  pre-institution 
experiences.  He  is  apt  to  gaze  at  one  fixedly  without  speak- 
ing when  one  would  normally  say  something.  His  teachers 
report  that  he  has  silly  ways  of  laughing  and  talking,  and 
that  he  lies  and  uses  profane  and  obscene  language. 

The  written  tests  reveal  mis-spellings  and  mis-writings 
that  amount  to  a  form  of  agraphia.  Much  of  the  writing  is 
utterly  illegible  and  the  lines  deviate  from  the  horizontal  by 
as  much  as  forty  degrees.  He  writes  inarmes  for  marble, 
shicks  for  checks,  read  for  red.  liitir  and  liirc  for  ]]cr,  bift 
lire  for  i^nfe  lived,  scurk  and  curk  for  struck,  beiii^ap  for 
began,  crow  for  grow,  iiirii  for  fiini.  luoom  for  woman,  pech 
for  piece.  These  arc  but  a  minor  part  of  his  mis-writings. 
Yet  so  far  as  his  writing  can  be  read  it  indicates  that  his 
thought  has  been  proceeding  naturally,  if  simply,  but  it  has 


ci.JNitAL  srL'i,)ii:s  <)i-  i;()Ki)i:u  casks.  147 

been  c^l)scure(l  In  liis  defeclive  imans  of  expression.  I  here 
seems  to  be  a  fundamental  defect  of  language  whicb  may  ac- 
count for  much  of  N'incent's  troul)lc  with  and  dislike  for  his 
school  work.  It  ma\-  i)ossii)ly  account,  as  well,  for  his  con- 
fusion of  certain  memories. 

\Ve  have  here  a  boy  who  has  some  resources  along  with 
some  decided  defects.  .Much  may  be  done  for  him  l)\-  util- 
izing the  former  and  mininn'zing  the  effects  oi  the  latter.  The 
defects,  however,  seem  to  be  part  of  a  fundamental  lagging 
in  development  which  1  am  not  sanguine  of  seeing  removed 
]j\'  anv  treatment. 


148 


I'.Ae  K\\  AKI)   AM)  FEEBLE-MINDED  CHILDREN. 


Darid  F.,  Age  Xiiictccn  Years. 


CASE  34.— Dwarf- 
ed and  Apparently 
Hydrocephalic.  Dull, 
but  Well  -  Balanced. 
Industrious  and 
Trustworthy.  Lacks 
Self  -  Direction  and 
Spontaneity. 


David  is  one  of  the  institution's  steadiest  and  most  reliable 
boys,  here  since  June,  1002.  His  large  head,  short  stature, 
slow  and  even  gait,  make  him  a  familiar  figure  about  the 

institution.  There  is  no  record 
as  to  his  fan.iily,  and  we  know 
onlv  that  he  had  been  in  one  of 
Chicago's  charitable  institutions, 
that  he  was  in  school  three  years, 
and  that  he  was  considered  to  be 
hydrocephalic. 

I'hysically  he  is  about  forty 
pounds  below  the  normal  in 
weight  and  8.7  inches  below  in 
height,  and  of  stock}-  build.  His  head  measures  thirty-three 
inms.  more  than  the  normal  circumference,  and  is  asymmetri- 
cal in  total  configuration  while  fairly  regular  in  details.  He 
shows  seventy-six  cu.  in.  less  than  the  lung  capacity  usual 
to  his  age.  and  his  strength  of  grip  is  one-third  less  than  the 
normal.  Vision  is  but  two-thirds  in  either  eye,  and  his 
hearing  is  slighth-  dull  on  the  left. 

His  lips  are  thick  and  his  palate  is  square-angled,  flat, 
and  liroad.  The  palpebral  fissures  are  not  large,  the  skin 
is  dark,  there  is  slight  lordosis,  and  the  general  body  bal- 
ance is  not  very  well  maintained.  There  has  been  no  medical 
examination,  but  he  has  been  considered  to  be  healthy. 

In  school  David  reads  "ver)-  intelligently"  in  the  fifth 
reader,  w^orks  problems  in  fractions  and  even  some  in  "In- 
terest," is  good  at  spelling  and  fair  but  not  neat  in  drawing. 
He  is  awkward  in  calisthenics  and  in  dancing.  In  manual 
work  he  is  verv  satisfactory,  "has  ideas"  and  uses  them  in 
arranging  his  work,  chooses  the  right  tools  and  goes  ahead 
using  them  with  skill.     He  recognizes  his  mistakes,  of  him- 


CL.INTCAr.  S'lTDIKS  Oi'   I!()kl)i:i<  C  ASI'. 


149 


self,  lie  sliows  imicli  iiilt-rest  in  ln>li)r\,  alleii(l>  well,  14-015 
on  well  with  others,  is  tnislworthw  cle.'inlw  and  ■"newr  j^ets 
excited."  Me  ])la\'s  solo  l'>  llat  clarionet  in  the  hand  and 
orchestra,  makes  al)oul   normal  ijroore^-  here',  and   "will  he 


DAVID    F 


a  good  sight  reader  and  a  good  clarionetist,"  to  quote  his 
instructor. 

When  questioned  David  readily  told  nie  the  capitals  of 
California,  Texas,  Illinois,  and  the  United  States,  the  names 
of  the  largest  and  the  smallest  ocean,  the  boundaries  of  his 
own  state,  the  name  of  the  largest  city  in  California,  in  [lli- 
nois.  and  in  the  Cnited  States,  etc.     lie  said  the  l\evolntii>n 


150  IIACKW'ARD    AND    F EKlJLi:- Al  IXDKD   CHILDREN. 

occurred  because  England  would  not  let  the  colonies  send 
men  to  Parliament  to  help  make  laws.  His  answers  were 
given  in  a  uniformly  intelligent  manner. 

Fairly  informed  and  well-adapted  as  he  seems  to  be  in  the 
knowledge  current  in  the  school,  the  request  to  do  a  few 
simple  operations  with  numbers  gave  a  significant  kind  of 
failure :  Asked  to  multiply  20  X  476  he  was  completely 
confused  and  finally  gave  as  the  product  1 167^3.  He  divided 
a  five-place  number  bv  2^,  correctly  enough  until  he  obtained 
a  remainder  of  16,  which  he  added  to  the  quotient  as  .16. 
This  does  not  mean  that  David  cannot  think.  He  daily 
proves  that  he  avi  think  in  the  shoe  shop  and  manual  train- 
ing room.  lUit  it  does  show  that  with  these  abstractions 
thinking  was  at  least  very  difficult  for  him. 

Examination  with  the  Ijinet  scale  gave  David  a  mental 
age  of  eleven  and  a  half  years,  a  retardation  of  seven  and  a 
half  years.  He  was  steady,  without  a  trace  of  confusion 
or  emotion.  Even  the  presence  of  a  roomful  of  visitors  did 
not  afl:'ect  his  responses.  ( )n  being  partially  re-examined 
later  he  gave  about  the  same  results  and  with  the  same 
equanimity.  He  shows  some  distinct  defects  of  articulation, 
but  otherwise  his  reading  of  an  ordinary  page  was  fluent 
and  was  practically  without  errors,  though  with  a  reading- 
class  drawl.  His  reactions  in  these  tests  were  sane  and 
sound  as  far  as  his  mental  resources  permitted  him  to  go, 
but  he  was  not  very  spontaneous  or  able  in  his  thinking, 
and  was  slow  and  easy-going. 

In  the  written  tests  his  handwriting  is  rather  awkward  and 
scrawled,  but  is  fairly  legible.  The  capitals  and  marks  are 
usually  correctly  placed,  and  he  rarely  mis-spells.  His  com- 
position shows  logical  and  natural  sequences  thruout,  but 
with  no  originality  anywhere,  except  that  in  making  up  a 
story  of  the  trip  in  a  flying-machine  he  reviewed  a  few  geo- 
graphical points  that  one  might  cover  in  such  a  trip.     The 


ci.iNiCAi.  s'lL'DJi'.s  oi'  i!()UI)i:k  cases.  151 

results  in  all  these  tests  show  steady,  effective  work  of  mod- 
erate quantity  and  quality,  on  the  whole  hardly  stronjT;er  than 
his  Binet  level  would  su.^gest.  \'isual  defect  nia\-  have  had 
to  do  with  the  fre(|uenl  onnssions  in  the  A-te,sl.  Ilis  ahimr- 
mallv  slow  rate  in  tai)])in^-  with  either  hand  reminds  n^  i>f 
his  awkwardness  and  sltiwness  df  m(i\ement  in  wirinus  kinds 
of  activity. 

David's  ])hlei;matic  disposition  and  trustworthy  moral 
character  i^'wv  him  a  i^"reat  advantai;e  in  niakiui;-  social  a<la|)- 
tations.  lie  has  worked  faithfully  at  shoe-making;'  until  he 
practicalK'  knows  the  husiness  in  its  sim])ler  details,  and  he  is 
inclined  to  follow  it  as  a  trade. 

We  have  here  a  hoy  who  is  hut  very  little  l)elow  the  horder- 
line  of  feehle-mindedness,  and  who  is  so  happily  halanced  in 
his  reactions  and  conduct  that  his  readiness  to  conduct  his 
own  aft'airs  is  apt  to  he  over-rated.  He  proved  the  latter  by 
a  test  of  his  own  contriving:  Prompted  probably  l)y  the  ex- 
ample of  more  restless  spirits  rather  than  by  inherent  discon- 
tent, he  ran  away  and  remained  away  for  some  little  time. 
But  he  was  unable  to  "make  it  go"  or  to  know  what  to  do, 
though  abimdantl}-  able  to  earn  a  living  at  shoe-repairing 
or  at  other  work.  He  was  finally  retiu-ned.  has  seemed  to  be 
more  contented,  and  is  doing  well. 

Such  a  child  must  l)e  trained  to  a  self-supporting  occupa- 
tion, luust  be  furnished  permanent,  kindly,  directive  control, 
and  must  in  some  way  be  prevented  from  reproducing  his 
kind.  At  present,  institution  life  is  the  solution.  But  chil- 
dren of  this  grade  can  seldom  be  retained  in  institutions ; 
and  for  still  other  reasons  society  should  undertake  the  task 
of  adapting  and  caring  for  such  children  ///  their  habitat. 
Social  agencies  in  the  home  city  should  be  fitted  and  em- 
powered to  exercise  the  necessar\-  control,  and  these  agencies 


152  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

together  with  special  schools  must  solve  the  problem  of 
fitting  such  children  to  render  useful  service  in  their  natural 
environment.  L'nder  such  a  regime  David  would  support 
himself  in  society  as  a  contented  shoemaker,  would  help  to 
entertain  the  community  with  his  music,  and  would  be  made 
to  live  the  life  of  a  useful  if  humble  citizen. 


CASE    35.- 

— Practi- 

cally   Norma 

1    Intelli- 

gence.     Mus 

cal,  and 

Skillful     at 

Work. 

Sulky      in 

Manner, 

with      Outbreaks      of 

Stubbornness.      A 

Problem      of 

Social 

Adjustment 

Outside 

of   Institutions. 

CLIXICAL  .S'JUUIIiS  OF  B(;RDF.K  CASES.  I53 

Theresa  II.,  Colored,  .h^e  Sixteen  cuid  Oiie-lialf  Years. 

The  case'  ci  this  colored  j^irl  is  of  interest  l)ecause  she  has 
sliown,  ill  the  tc'sts,  a  >lroii,!L:er  meiUahly  than  liaw  any  of 
tlie  (jthers,  and  ha^  earned  the  rii^ht  to  lie  _i;"rou|)ed  with  cer- 
tain   classes   ol'    iioniial    children. 

.She  came  to  Lincoln  from  one 
of  Chicaj^o's  charitahle  institu- 
tions, and  nolhiiiL^' conld  he  learn- 
v(\  of  her  faniiK.  .She  was  horn 
in  Kansas,  was  inclined  to  he  dis- 
obedient and  s])niik\  and  at  tiiiics 
refused  to  work.  .She  amnsed 
herself  by  readiiiiL^  and  had  been 
in  school  two  years.  .She  tells 
me  herself  thai  she  was  first  in 
a  ( dhcaiio  llonie  for  the   I'rieiid- 

less.  then  in  an  industrial  School  till  she  finished  the  fonrth 
g'rade  work,  then  in  a  i)rivate  home  till  she  finished  tiftii 
,^-rade  school  work,  and  was  then  ])laced  in  the  charitable 
institution  whence  she  came  to  Lincoln.  Ilere  she  ha< 
worked  in  tlie  laundr}-  forenoons  and  attends  school  alter- 
noons,  takin^i'  onlv  sewing',  music,  and  calisthenics. 

I'hvsicalh-  Theresa  is  ten  ])ounds  heavier  aii<l  an  incli 
taller  than  most  i^irls  of  jier  age.  I  ler  head  has  tweiUy-twt 
mms.  more  than  the  normal  circumference,  the  excess  beiiit;" 
in  the  unusual  develo])ment  of  tlie  forehead,  which  ])rojects 
far  beyond  the  eyes.  The  jaws  also  project  well  forward, 
the  base  of  the  nose  is  low,  the  lips  are  thick,  the  thyroid 
is  slightly  larger  than  normal.  She  has  a  slovenly,  untoned 
carriage  in  walking  and  when  seated,  but  shows  no  other 
bodily  defects.  ^Medical  examination  revealed  some  impair- 
ment of  the  right  lung,  but  her  health  is  generally  good. 
LTer  lung  capacit>-  was  twenty-nine  cu.  in.  below  the  normal. 


154 


UACKW  AKD    AND   FEEBLE-MINDED   CHILDREN. 


but  in  strenglh  of  grip  she  exceeded  the  normal  with  the 
right  hand,  and  her  left  was  three  kilograms  stronger  yet 
than  her  right,  though  she  is  not  left-handed.  Her  vision 
and  hearing  are  normal. 

In  school  she  gets  on  well  with  others  and  attends  as  weU 

as  normal  girls  usually  do. 
In  the  calisthenics  class  she 
is  called  the  best  pupil.  Her 
violin  teacher  is  very  proud 
of  the  progress  that  Theresa 
makes.  She  likes  her  music 
and  "sticks  to  it."  learns  her 
pieces  aptly  and  well,  and 
for  a  good  while  has  played 
violin  selections  in  the 
school  entertainments.  In 
the  sewing-room  she  does 
her  work  beautifully.  .She 
works  slowly,  but  the  work 
is  of  fine  quality  and  she 
readily  catches  new  ideas 
about  it.  She  is  very  quiet, 
m  .  I   (  iPBi      talks    pleasantly    with    the 

ALt  i  H,!      girls   but   not    with   others. 

^Hf  I  |p{      nods  her  head  or  hardly  re- 

^B  f  ''  1l|      plies  when  spoken  to  by  her 

""'      teachers.       and      regularly 

maintains   a   sulky  attitude 

and     manner.       Sometimes 

she  has  to  be  coaxed  to  go 

to  her  class  exercises,  but  she  goes.     The  girls  all  seem  to 

like  her  in  spite  of  her  color  and  her  sulky  manner. 

In  the  mental  examination  she  passed  all  the  Binet  tests 
through  twelve  years,  passed  the  first  paper-cutting  test  and 


T II  EKES  A    II. 


ci,iXJC.M.  SI  i'i)ii-;s  ('I-  ii()Ki)i:i<  casi'-s.  155 

the  test  for  ojiposites.  and  c.-ii'ikmI  half  cTecht  in  another  of 
the  tests  for  fifteen  \ears  and  aho\e.  Slie  was  oiven  only 
fonr  of  tlu-se  !ii:^lirr  tests  of  the  scale,  as  this  ])art  of  it  was 
not  yet  formulated.  Iler  res])onses  were  intelli,uentl\-  ^iven 
and  showed  absolute  steadiness  and  control. 

In  the  written  test>  her  handwritini;'  is  Ic^ihle  and  nor- 
mal. I^ver\'  word  is  s])elled  correctlw  includiuL;  such  words 
as  f^rdcstal.  beautiful,  statue,  Clirisluias,  Court  Hc.isr,  ijuar- 
rcl,  and  prettier.  "^W  uses  few  ca])itals  and  marks.  Iler 
composition  is  not  infantile  thou.i^h  fairly  sim])le.  .and  shows 
nonual  secjuences  i^'enerally.  In  one  ])lace  when  tellini;'  of 
the  l)ean's  narrow  escape  from  death  she  makes  him  sa\'.  "I 
have  just  escai)ed  a  narrow  death."  She  is  too  slow  to  .^ive 
a  verv  lari^'e  output  in  the  story  rei)roduction  and  invention, 
hut  what  is  t;iven  is  (_)f  normal  qualit}-  th.oUi.ih  showinj.;-  but 
little  imagination.  She  wrote  ten  opposites  in  the  first  min- 
ute of  the  test,  and  wrote  all  of  the  o])])osites  and  similars 
correcth'.  She  crossed  05  A's  in  two  minutes  at  the  first 
trial  and  all  of  the  100  at  the  second  trial.  She  made  no^ 
errors  here,  and  gave  no  inccM-rect  details  in  rej^roducing 
stories.  All  this  speaks  well  for  the  normality  of  her  intel- 
ligence. 

The  attendants  find  Theresa  to  be  a  most  capable  laun- 
drv  \vorke\ .  who  does  nicely  the  finer  as  well  as  the  heavier 
ironing,  and  is  able  for  "the  work  of  an  attendant"  and  who 
generally  works  pretty  well.  I'.ut  by  times  she  becomes  sul- 
len and  stul)born,  and  may  refuse  to  work.  In  these  m(^(^ds 
she  has  even  gone  so  far  as  to  take  a  hot  knife  and  brand 
other  girls,  causing,  however,  only  superficial  burns  and 
probably  not  intending  to  injure  them  seriously. 

It  is  the  ca.se  of  a  girl  wdiose  intellect  is  of  a  strength  to 
fioat  her  at  work  in  society  ;  w  hose  intellect  is  not  only  of  suf- 
ficient quality  but,  unlike  that  of  Prudence  S.  and  Viola  H., 
it  is  not  frail,  docs  not  show  tendencies  to  confusion.     I  Tow- 


156  BACKWARD   AND  FEEBLE- MINDED  CHILDREN. 

ever,  in  the  levels  above  twelve  years  of  mental  age,  defects 
when  present  are  apt  to  manifest  themselves  on  the  side  of 
the  feelings  and  the  emotional  control,  in  will  and  action  and 
in  the  social  relationships.  With  Theresa  there  is  some  ab- 
normality in  all  of  these.  She  works  too  slozuly  for  the  pace 
of  life  outside,  does  not  get  very  much  done  in  spite  of  her 
good  quality  of  performance,  and  rightly  or  wrongly  is  really 
accounted  to  be  lazy.  She  has  a  dogged,  sullen  attitude,  with 
difficulty  in  maintaining  normal  social  relationships;  and  al- 
lowance must  constantlv  lie  made  for  these  peculiarities,  al- 
lowance, however,  which  is  not  so  readily  granted  outside 
of  such  institutions,  \^'hile  not  explosively  emotional,  Ther- 
esa has  a  "sneaking  way  of  getting  even"  and  of  getting  out 
of  things,  and  her  abnormal  sulkiness  could  easily  be  trans- 
formed into  viciousness. 

Still,  this  girl  has  quite  as  good  a  mind  as  thousands  of 
colored'  girls  who  are  making  their  own  way  outside.  She 
is  not  "feeble-minded"  in  any  technical  sense,  and  T  should 
like  to  see  her  tried  at  work  outside,  if  possible  under  proba- 
tionary direction  with  at  least  the  privilege  of  return  if  that 
should  seem  best. 


chapti-:r  v. 

TAi;i'LA'ri(  )XS  ol'    DATA.  Sl(  i(  il-.Sl  l-:i )  (■kOli'S, 
AND    LINES   Ol'    TKAXSmoX    I'KO.M    I'i'.i'.l'.Llv 

.aiixi)p:!)Xi^ss  to  x()X-i'"i<:Kr.iJvM ixdi-.dxess. 

Some  of  the  luc'isurcnK'Ht^  ami  tc^t^  lia\c  ]k\'u  made  nii 
])racticall\'  all  of  the  cases.  The  results  of  most  of  these,  as 
far  as  the\-  lend  themselves  to  numerical  statement,  are 
Ijrought  toi^ether  in  the  tables  of  h'i.Li's.  31-35.  It  is  to  he 
remembered,  however,  that  the  i)ur])ose  of  these  studies  has 
been  clinical  and  not  statistical:  and  for  the  most  jiart  it  is 
better,  for  the  present,  to  refrain  from  making-  i^enerali/.a- 
tions  upon  the  avera.t^es  stated.  Many  of  the  tests  have  l)een 
sttfificientl}'  described  in  the  studies  themselves,  or  are  al- 
ready familiar  from  other  sources.  1  shall  here  state  l)rietl\- 
the  conditions  and  norms  observed  in  certain  ot  the  tests 
and  measurements,  information  as  to  the  others  bein^'  easily 
accessible  in  the  manuals  ot  tests. 

The  Binet  scale  was  used  in  the  form  i)ublished  b_\-  llinel 
in  1908.  Dr.  ( ioddard  is  doubtless  rii^'ht  in  considering-  that 
this  scale  measures  the  amount  of  retardation  about  as  cor- 
rectly as  does  anv  later  revision.  It  includes  tests  for  read- 
ing-, writing.  memor\-  for  what  is  read,  etc.,  which  are  soiue- 
times  referred  to  in  these  studies,  and  which  are  not  in  the 
revised  scale.  Their  natm"e.  however,  is  doubtless  sufh- 
cientl}-  clear  from  the  references  to  tlieiu  in  the  studies. 
Reliance  has  not  been  placed  on  the  old  test^  for  the  fliir- 
tccii-year  level,  w-hich  were  too  difficult,  and  which  in  an;.- 
case  were  seldom  reached  1)\-  our  children.  The  tests  were 
applied  essentialh-  as  directed  in  m_^  syllabus  of  them,  ])ub- 
lished  in  the  jonriial  of  Jiducatioiial  I'sycholo^^y  for  Oc- 
tober,  19  TO. 


157 


158 


I'.ACKWAKD    AXU   Flil£liLE-M  INDED  CHILDKKX. 


W) 

_ 

«5 

<se 

e<i 

i« 

CO 

W 

C~ 

o 

o 

e<i 

^> 

eM 

e<i 

^* 

W 

oa 

PJ 

*" 

eq 

"" 

us 

to 

<x> 

oe 

OO 

'    e 

ifi 

OS 

Oi 

<9" 

o 

oe 

lA 

eo 

"■ 

■      M 

•"■ 

e<s 

r-( 

»» 

*1 

"^ 

•^ 

fO 

|jpzi;z;:z;o;z;;z;:zi;^«^;*"!o 


;z;  <« 


I 


C3 

"■.  c 
o 


2;:2^2:;^:^z;z;*:z2:Z2:o^;' 


I  a 


j^  Z  *  2;  *  2;  "^ 


'^2   2^ 


".  2;  <« 


*;  ^ 


CO      CD  CO  CO  CD 

cocot^ce^vcoiAce 


CO  in  CO  A 


i:E 


K.E 


CO   S9 

CO  oe 


lA   ^^       r^      CO 


»j<     »  ^r  o   O 

l«   I— I   e*  ^*   Ift    r-l 


00   ^f   ^^   CO 


^<  OS  us  ^<  r-   r-   r- 


e>]-^e<icoeo«-"e>)or) 


—  CO 


I—    O    OD 
OS    -^    C^ 


I— i-tt^-iost— leot-cMT— ( 


-*  CO  o 


CO  --H  — "  e^]  r-  CO  — " 


cDaoeoeocri^"Os^<<M 

'      .-<      CO      CO      "-H 


aoe<iiDi/9»—    ecus       t-       ce 


^N    .-.  e<i    64    r-H    ea  i— i 


oeos^rr^^^osco^^co 
-i  OO     1— I  t— I    e<i     CO 


CO      ^f      ^      OO 


•-<     e^i    .— I 


eocoosO'— icMOsos 


-<      00      CO 


(M    OS       00      us 


CO      CO      —>      1—1 


OS      -H      — 1      OS      t» 


OO      OO         CO         CM 


H«     OS         ^"  •« 


1-  ?. 


CO    1— I    i-i    1-1 


>  o  >  -  o  > 

uj  S  S  eci  c/2  ><:q3<<oh<iJ 


—  a 


So 


a< 


9  ^ 
O.S 


TAUUr.ATlOX    Ol'    UA'iA. 


m!» 


^J  I   Z 


3hJ 


w 

I 

a: 

< 

CO 

fa      Q 

o 
o 


W.S 


^£ 


to    to 


Q 

us 

m 

00 

l/B 

(>J 

t- 

CD 

CO 

to 

r-l 

-^ 

e* 

^  5 

lO 

C^J 

r-l 

00 

^ 

CO 

Oi 

.. 

00 

to 

iD 

IN 

CQ 

Oi 

as 

lO 

lA 

o 

-"s 

CO 
1—1 

00 
CO 

(M 

t^ 

o 

o 

'-£> 

m 

en 

1/5 

«:> 

'^ 

:^:z;^;z;:z;;z;oz:2;2i^^^:?:z;^^ 


Z;Q^^ei2^o;z;oz:zZZZ2:ZZ' 


:^  2  :^  ^  ^. 


in     eo     iC     ^j-     c^t     ^    CO 


y. 


Z   '^.   z 


z  z  z 


u>  — 


z  ^  z 


CO      "Xi      M      C>3      00      -t     -<      t~      ^D      LO      -^     M      CO      t- 


(M      l«  ^      M      t~ 


eqio     '*coooe<i'M^ 


i»-r<Mco     (Ncocot—    cot-iwr- 


aOMLOr--^-<ae«sa5-<05-^«ee««Oi«"0       *- 


■r}iiA;cr-i-7aocot:^aie«2'XJe^oO!e5C'i<«oiN 


e<i     »    c^l 


eortuir-     oococ<l»'i"r-'9>t^ 
CO  iM    -I    iM  e>j 


CO 

CO 

OS 

IN 

00 

IM 

^ 

LO 

w 

^ 

« 

e<9 

QC 

OS 

^r 

X 

iM 

^ 

« 

-' 

(M 

CO 

^ 

CO 

^ 

e<i 

— 

iM 

^r 

^ 

(M 

lO 

CO 

00 

^" 

t^ 

„, 

IP 

QO 

ai 

c- 

00 

t^ 

00 

t> 

^ 

00 

^ 

CD 

iM 

CO 

O^ 

^r 

e<i 

■^ 

c~ 

o 

o 

CO 

O 

z: 

CO 

- 

HIM 

rtW 

HW 

HIO 

H(M 

rtl« 

rtPI 

HM 

HlO 

rt«M 

HtM 

^^?^ 

HlOl 

«9" 

= 

HtN 

HC) 

HIM 

CO 

(M 

CO 

o 

CiJ 

CO 

o 

C^J 

T— 1 

lO 

^ 

""^ 

""* 

""• 

'"' 

CM 

CM 

'"' 

■"^ 

'"' 

<Z^Kffi<3dc^OJ^^;^ffi^OQ 


.   ^   m 


mcQQQfiiffiKK:szcL;(i;H>^^^<o 


160  liACKWAKD    AND   F]':i£l!Li;-M  1  NDKD   ClllLDKliN. 

The  norms  used  in  the  tables  of  Figs.  31-32  are  taken  from 
the  Chicago  Child  Study  Reports,  with  the  exception  of 
those  for  cranial  measurements,  which  are  from  West  and 
MacDonald  as  given  by  Whipple.  The  cranial  measure- 
ments are  those  for  greatest  circumference,  greatest  length, 
and  greatest  breadth,  measured  with  steel  tape  and  the 
Smedley  cephalometer.  The  spirometer  tests  were  made 
with  the  ordinary  wet  spirometer,  counting  the  best  in  three 
trials.  The  Smedley  dynamometer  was  used,  counting  the 
best  in  three  trials  with  each  hand.  The  tapping  was  with 
the  Jastrow  key  and  the  counting  register  was  used,  check- 
ing for  errors  by  using  the  kymograph  or  by  careful  obser- 
vation. Both  the  Snellen  and  the  McCallie  cards  have  been 
used  for  testing  vision.  The  McCallie  audiometer  was  used 
for  some  of  the  cases,  but  the  results  tabulated  are  those  for 
practical  normality  shown  in  hearing  low  conversation  or 
whispering,  at  distances  established  as  norms.  The  results 
for  case  P.  S.  are  not  counted  in  making  up  the  averages  for 
any  of  the  tables,  as  it  was  desired  to  know  the  averages 
only  for  children  who  were  found  to  be  defective  in  intelli- 
gence. 

In  Fig.  33  Story  I  is  of  "The  ^farble  Statue,"  given  as 
directed  in  Whi{)ple's  Manual.  It  contains  i6fi  words  and 
sixty-seven  "details."  Story  II  is  of  "The  Straw,  the  Coal, 
and  the  llean,"  and  contains  568  words  and  200  "details."* 
It  was  read  to  the  children  as  for  Story  I,  and  the  results 
were  treated  similarly,  in  each  case  allowing  twenty  to 
twenty-five  minutes  for  reproduction.  In  almost  no  case 
was  more  time  desired. 


*This  is  taken  from  a  supplenientaiy  leailer.  "Si.xteen  Stories,"  pubiisbed 
by  A.  Flanagan  Co..  Chicago.  It  is  a  simply  told  tale  of  the  escape  of  these 
worthies  from  the  pot  and  fii-e  of  an  old  woman  ;  of  their  recounting  their 
adventures  and  journeying  together  to  a  stream,  where  the  straw  and  coal 
met  disaster  while  the  bean  laughed  till  she  burst  her  skin.  She  was  sewed 
up  by  a  kindly  tailor,  but  still  liears  the  scar. 


TAIUJLATIOX    OF    DATA. 


Ifjf 


MEN'l'AL  TESTS   OK    P.Oix'DKR   CASES. 


\so. 

story  lU' 

1 

S|..r. 

ltd 

.  ,      1     story 
"■        Inven. 

Oii( 

Illation. 

Name. 

s-ci 

CO     . 

■a  p 

'"  *^ 

t.ts!  Jsoi  !?2;1  u 

0  C  '     "   !-■ 

F.  A 

12 

61 

8 

2 

0 

0 

0 

1 
0      0 

48      9 

F.   J 

12.5 

18 

5 

0 

39 

6 

6 

14      0 

51 

24      2 

C.  H 

13 

48 

13 

1 

120 

25 

5 

29    15 





F.  N 

14 

77 

16 

0 

94 

20 

1 

33    22 



V    C.             -     - 

14 
14.5 
15 
16.5 

92 
0 

58 
146 

22 

0 

13 

35 

0 
0 
2 
2 

249 
22 

89 
273 

54 

0 

23 

66 

*    1 

0 
0 
0 

82    13 

0      0 

53      0 

66    93 

54 
21 

J.  H.— 

48'     4 

R.  P. 

G.  J 

14      1 

K.    M 

17 

58 

9 

0 

119 

32 

0 

17      0 





D.    F 

19 

144 

37 

2 

313 

77 

3 

76  107 



M.  E. 

36 

157 

42 

1 

282 

73 

3 

41 i 100 

0 

0      0 

Boys'  Av 



78 

18 

1 

1 

145 

34 

2 

37    32 

— 

w. 

H. 

P. 

H. 

B. 

N. 

P. 

W. 

F. 

B. 

D. 

T. 

M. 

H. 

W. 

D. 

V. 


D 

G 11   69  22 

S 11.5  ](l(l  19 


12.5 — 45  60   6 


E 

A 

I 

A 

C 

H 

N 

H 

H 

G 

A 

J 

M 

H 


(iirls'  Av 

Total  Av 


20j  () 

38^  8 

iOO'  20 

155  39 

11  2 

142  31 

15.5  150  38 

16.5  148  35 

17  '  94  22 
18.5  — 
20   17 
22   23 


23.5  170  49 


2(i 
47 

(I 


24 
29 


1  106 

0  8(; 

0   0 

1  (; 

0  85 

2  134 
7  238  46 
0  1)8  21 

10  231  .52 

4  89  l(i 

0  134  30 

0  99  25 

._.:248,  59 

Oi  76  221 

0  iV  8 

1  451  132 


33 
11 

0 

15 

23  0 

3  14  ()5 

(i  28  147 

2  42  0 

3  57  57 

1  58  48 
0  21  62 

2  55   4 
2, 
0 


3(; 


6  41 
3  59  131 


41  ___ 

0  ___ 
0  90 


64 


90  69 


18  68  54 


)   0  24 


...81.2  20.5  1.3  136  33   2  33.7  36 

...79.8  19.5  1.2  140  33.5   2  35.2  34.3  51  44  38 


l62  lJyi<.rvWAl<D   AND  FEEBLE-MINDED  CHILDREN. 

In  the  test  foi  'story  invention."  the  children  were  first 
interested  in  a  boy  and  his  sister  who  Hved  on  a  farm  near 
Springfield,  Ih.,  and  who  were  given  for  a  Christmas  present 
a  flying-machine  which  was  so  simple  that  they  could  fly 
with  it.  The  day  after  Christmas  they  placed  in  it  food  and 
coffee  to  last  them  two  days,  and  with  fifty  dollars  given 
them  by  their  grandfather  they  sailed  away  to  see  the  world. 
What  would  they  see,  and  what  would  happen  to  them  imtil 
their  return?  Fifteen  minutes  were  given  in  which  to  write 
a  story  of  the  trip,  making  believe  that  the  child  tested  was 
one  of  the  two  lucky  children.  All  began  with  apparent  en- 
thusiasm, but  scarcely  any  wanted  more  time.  The  tendency 
to  automatic  repetition  shows  in  the  children's  written  re- 
hearsal of  my  preliminaries  in  spite  of  being  cautioned  to 
write  only  of  the  trij). 

The  tests  for  directions  known  and  for  remem1:)ered  rela- 
tive locations,  groujjed  as  "orientation"  tests,  were  newly 
devised,  and  have  been  described  in  the  studies.  They  are 
quite  worth  trying  out  with  normal  pupils  of  successive  ages, 
to  establish  norms.  The  essentials  are  (i)  to  place  in  rela- 
tive order  the  pictures  of  nine  of  the  buildings  or  resorts 
which  are  best  known  to  the  child;  (2)  to  indicate  the  direc- 
tions of  four  well-known  places,  two  distant  and  two  local ; 
(3)  to  indicate  the  directions  of  the  four  cardinal  points. 
The  time  is  not  limited. 

The  test  for  similars  was  newly  arranged,  and  proved  to 
be  fully  as  valuable  as  that  for  opposites.  The  directions 
were  to  "Write  a  word  that  means  something  like  what  this 
word  means,  a  word  somewhat  similar  to  this  word  in  mean- 
ing." Sufficient  examples  were  given  to  illustrate  thor- 
oughly. The  list  follows:  Night,  love,  tobacco,  tent,  sweep, 
feel,  board,  lightning,  bird,  stone,  foggy,  dark,  pretty,  afraid, 
daisy,  winter,  big,  snow,  coat,  run.  The  first  test  for  similars 
was  given  as  for  opposites.  giving  ten  to  eleven  minutes  to 


TAIUJl.ATKJ.X     Ol-     l».\r.\.  163 

write  the  "similars"  on  the  printed  shp.  I'est  I  I.  for  similars, 
j^iven  to  the  boys  on  the  following;-  day  and  usin^"  the  same 
list,  was  as  follows  :  The  children  had  blank  slips  with  spaces 
mnnbered  from  one  to  twenty.  The  words  were  pronounced 
to  them  as  distinctly  as  possible,  with  a  pause  of  about  forty- 
five  seconds  after  each  in  which  to  write  its  similar.  The 
directions  and  illustrations  were  repeated. 

In  the  tests  for  opposites,  Whipple's  lists  A  and  \'>  were 
used,  and  his  directions  were  ijiven.  The  children  wrote 
for  sixty  seconds,  and  the  results  were  recorded  ;  then  ten 
minutes  more  were  given  to  complete  the  list.  Test  1 1  was 
given  on  the  day  following  Test  I,  and  with  a  different  list. 

I""or  the  A-cancellation  tests,  the  Xorsworthy  lists  OV 
and  GA,  the  former  given  also  by  Whipple,  were  used,  and 
Whipple's  directions  were  followed,  using  a  constant  time 
of  two  minutes  each  for  Tests  11  and  HI.  In  Test  1.  given 
only  to  bovs,  an  accident  interfered  with  the  time-taking, 
and  the  time  may  have  been  a  little  less  than  two  minutes. 
The  test  is  otherwise  entirely  admissible.  The  boys  had  an 
advantage  over  the  girls  in  having  the  ])reliminary  practice 
furnished  by  this  test,  the  tests  being  given  in  seciuence  as 
numbered. 

Professor  Binet  considered  that  the  A-test  was  a  satis- 
factory test  of  the  attention,  but  only  when  the  children  were 
left  together  to  do  the  w'ork  in  the  absence  oi  their  teacher 
or  other  care-taker.  This  test  was  tried,  the  children  being 
reminded  that  some  people  thought  thev  would  not  stick  to 
work  w'hen  their  teacher  was  away.  The  result  was  that 
more  was  done  in  the  absence  of  all  supervision,  though  with 
many  more  errors  by  the  girls.  The  appeal  to  the  children's 
pride  seemed  to  meet  a  definite  response,  and  had  something 
to  do  with  increasing  the  out])ut. 


164  1;ACK\\  AKl)    AXU    FEliBLE- MINDED   CIllLDKEN. 

MENTAL  TESTS   OF  BORDER  CASES. 


Test. 


Similars. 


liisht. 


WroiiK. 


I       11 


Oppositos. 


A— Cancellation. 


I       II 


II  Min.      Crossed. 


Omitted. 


I       II  I  I       II    III 


I       II    III 


Name.  Atje. 

F.    A 12 

F.  J 12.5 

C.  H 13 

F.  N 14 

V.    0 14 

J.    H 14.5 

R.   P 15 

G.  J l(i.5 

K.  M 17 

D.  F 19 

M.  E 36 

Boys'   Av. 


0 

9 

13 

10 

12 

1 

9 

20 

3 

20 

14 


10     4 


5.5 


3(? 
11    10 


7.5,  9.3 


44   62 

67  80 
52  i  66 
71 


44   68   80 


0 
62 
8 
2 
0 
5 
3 
1 

70 
10 
28 


17 


0 
6 
0 
2 
4 
7 
1 
0 
43 
19 
3 


11  7.7 


H.  G 11 

P.    S 11.5 

H.  E 12 

B.  A 13 

N.   L 13 

P.  A 13 

W.  C 13 

F.  H 14 

B.  N 15 

D.  H 15.5 

T.  H 16.5 

M.   G 17 

H.  A 18.5 

W.  J 20 

D.  M 22 

V.  H 23.5 

i 

Girls'  Av. 

Total  Av. ! 


10  — 

18  — 
0  — 
4  — 

12  — 

17  — 

17--. 

0  — 

19  — 

20  .-. 
20  -. 


3  — 
2__- 

2o;__. 

3-- 

li_-. 


12 

11 

1 

15 

0 
6. 

0. 
20. 


17 

___'  1 

16 

..__  2 

7 

.__  7! 

11 

—  71 

20 

ol 

1 

12.7 

—  4.7 

10.1 

4.5 

10  — 

19 

10  — 

20 

2 

4 

5  — 

« 

4 

8 

0 

8 

12___ 

20 

4.4 

9.4 

5-_ 

9.4 

1 

17   51 

47|  63 

49  77 
0   38'. 

35  44' 
631  87'' 
651  92' 

50  91. 
50'  67'. 
87  100 . 
95  100 . 
81I  98, 
80'  92 . 
60   89. 


6  0 

1!  2 

0!  0 

0  45 

2  1 

14  13 

3!  1 

7J  10 

1  7 
Oi  0 


84 

98' 

70 

97  — 

1 

59 

81___ 

63 

8lL__ 

2   13 

! 

3.4  6.6 
6.71  7.1 


Fig.    34. 


TAIiUl-ATION    OF    DATA.  165 

For  the  association  tesl>  tabulalal  in  I-'ii;-.  35.  the  list  of 
TOO  words  used  1)\-  Kent  and  Rosanoff'  was  used  with  all 
but  cases  F.  A.,  1".  J.,  j.  11.,  and  y\.  E.  .\  list  adapted  from 
Wehrlinf  was  used  with  the  others,  who  were  tested  before 
the  Kent-Rosanotf  ni()no,L;ra])h  reaclu'd  me.  The  children 
faced  the  experimenter,  and  the  w^rd  was  pronounced  after 
a  preliminary  "Ready."  The  time  was  recorded  with  a 
stop-watch.  In  the  table,  ■"Common"'  is  used  as  with  Kent 
and  Rosanoff  for  the  words  that  are  to  be  foimd  in  their 
"Frequency  Table"  of  reactions  made  by  normal  j)ersons- 
The  "Normal,  single  word"'  column  includes  any  additional 
single-word  reactions  whose  relation  to  the  stimulus  was  an 
obviously  natural  one.  "Motor  Speech"  names  the  words 
given  because  of  their  habitual  association  in  spoken  utter- 
ance with  the  stimulus  word.  The  "horrors"  were  failures 
to  react  at  all.  Fgocentric  is  used  to  name  reactions  in  which 
the  stinudus  word  is  taken  to  make  immediate  reference  to 
the  child  himself.  They  can  hardly  be  said  to  have  occurred. 
The  other  rtibrics  are  used  as  described  in  the  case  studies, 
or  as  defined  by  Kent  and  Rosanoff.  Such  normals  as  are 
given  are  for  children  ttnder  sixteen,  and  are  taken  from 
Kent  and  Rosanoff,  except  that  the  median  reaction  time 
is  that  given  for  uneducated  adults  by  Jung.:j: 

It  will  be  noted  that  the  children's  ages  stated  in  the  later 
tables  vary  slightly  from  those  given  in  the  earlier  ones.  The 
tests  reported  in  the  former  were  made  at  a  correspondingly 
later  period. 

The  disproportionate  strength  so  frer[uently  shown   with 


*ICent  and  Rosanoff  :  A  Study  of  Association  in  Insanity.  .\ni(>rican  .Tour- 
nal  of  Insanity,  Vol.  IvXVII.  Xos.  1  and  2,  1910. 

tK.  Welirlin  :  I'eber  die  Assoziationcn  von  Iniliczillcn  nnd  Idiii1<>n.  .Tung's 
Studies,  I. 

tJung's  Diagnostisoho  Assoziations— Studion,  I,  p.  198. 


l66  BACKWARD   AND   FEEBLE-MINDED  CHILDREN. 

ASSOCS.  TO   100   GIVEN   WORDS. 


< 

b 

1-5 
fa 

-< 

«!5 

CM 

1-5 

6 

Q 

> 

< 

i— * 

-^s 

Ago 

12  12.5 

12.5 
57 

13 
67 

13 
24 

14.5 

1516.518.5 

i 

22 

36 

_ 

Xormal.  1  Word.__ 

21 

42 

16 

92 

89 

22 

83 

12 

48 

97 

Common 

39 
1 
1 

2 

66 
1 
0 

24 
0 
5 

0 

88 
0 
5 

84 
2 
3 

17 
0 
0 

75 
1 
1 

0 

56 

96 

Doubtful     — 

0 

Non-specific.  1  W'd. 

0 

5 

Phrase  or  Sent 

60 

0 

0 

1 

68 

50 

1 

1 

1 

0 

86 

— 

— 

Def.  bv  ditto... 

64 

0 

0 

1 

68 

49 

1 

0 

1 

0 

86 

— 

— 

Tautology 

9 

0 

0 

0 

15 

13 

0 

0 

0 

0 

2 

Sound   

2 

1 

7 

1 

0 

4 

2 

0 

42 

0 

0 

0 

Neologism   

0 

0 

0 

0 

0 

0 

0 

0 

5 

0 

0 

0 

Senseless 

0 
2 

0 
0 

0 
4 

2 
0 

0 
3 

0 
1 

0 
1 

0 
0 

0 
2 

0 
0 

0 

1 

— 

Motor    Speech 



Stereotypy  

0 

0 

0 

2 

0 

0 

1 

0 

0 

0 

0 

_-_       0 

Perseveration   

0 

9 

0 

4 

0 

5 

0 

0 

0 

2 

0 

__.      0 

Repet.  of  Stim 

1 

0 

1 

0 

0 

1 

0 

0 

3 

0 

13 

— 

0 

Errors,  Total 

9 

40 

30 

27 

4 

0 

1 

4 

24 

0 

0 

12.6 

0 

Errors  from  Ignor, 

2 

1 

1 

3 

3 

0 

1 

0 

0 

0 

0 

___ 

0 

Egocentric   

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

_._ 

— 

Reminiscent    

2 

0 

0 

0 

3 

0 

0 

2 

1 

0 

0 

— 



Unclassified  

0 

4 

4 

11 

1 

22 

2 

3 

5 

14 

0 



1 

Different   Reacs 

90 

48 

62 

54 

93 

98 

77 

94 

75 

89 

99 

80 

87 

Med.  Reac.  Time— 

2.0 

4.1 

2.0 

2.4 

2.3 

2.3 

1.4 

1.7 

3.0 

1.7 

1.7 

2.2 

2.0 

Pig.    35. 


TABULATIOX    OF    DATA.  167 

the  left  hand  niis^ht  lead  one  to  snppn^e  that  thor  chil(h-en 
were  left-handed.  Ilowever,  with  the  exception  of  .\.  L., 
who  is  left-handed,  and  of  C.  A.  and  M.  j.,  as  to  whom  there 
is  at  least  no  left-handedness  recorded,  the  children  all  used 
their  right  hands  preferahly  and  were  considered  to  l)e 
right-handed. 

In  spite  of  the  fact  that  a  majority  of  these  children  have 
defective  vision,  only  1'.  S.  was  wearing"  glasses  when  the 
tests  were  made,  and  only  D.  AI..  II.  E.,  and  ( l.  J.  have  used 
glasses  wdiile  in  the  institution,  as  far  as  could  be  learned. 

In  closing  this  review  it  may  be  of  interest  to  ])resent  the 
re.sults  of  a  little  test  of  these  children's  ideals  concerning  a 
life-occupation.  1die  children  were  asked,  "If  you  could  l)e 
what  von  would  most  like  to  l)e  when  you  are  a  man  (Or 
woman),  what  would  you  most  like  to  be?"  They  were 
given  plenty  of  time  for  reflection,  and  in  most  cases  t\.'rofc 
their  answers.  I'nfortunately,  some  of  the  cases  studied 
here  were  not  included  in  this  test,  but  such  as  were  gave 
the  following  replies  : 

Choick  of  Occupation. 

Fred   J Bandman. 

Felix  N P.lacksmith. 

Polly  A I  like  to  be  a  true  and  noble  lady. 

Jerry  IF Engineer  on  train. 

Uertha  A School  teacher. 

Robert    P Shoemaker. 

Dora  AF AFusic  Teacher. 

George  J Sailcir  or  a  good  farmer. 

Hester  A Churchmember  in  the  Baptist  Church. 

Minnie   G Nurse. 

Beulah  N I  would  like  to  be  a  Catholick  sister 

and  if  not  I  would  like  to  be  a  help  to  the  church. 
Marshall  E..  .Officer  of  law^  (with  a  list  of  second  choices). 


l68  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

Prudence  S Like  to  be  a  teaclier  when  I  get  big. 

Viola  H. Actress. 

Hilda  E A  show  actreuss. 

Wilda  C Would 

like  to  a  true  and  noble  lady  when  I   am  big. 

Fannie  H 1  wish  to  ])e  a  music  lady. 

Nora  L Music  Teacher. 

Delia  II.  .  .  .1  would  like  to  be  a  Clu-istian  when  I  grow  up. 

Wendy  j Dressmaker. 

Casper  IT Coiy  boiy. 

Kenneth  M Carpten   (carpenter) . 

Fritz  A Cow  l3oy. 

Vincent  C Basketniaker. 

David  F..  .A  good  nuisician  and  work  in  some  large  factory. 
Theresa  H Dressmaker. 

It  is  e^diliuit  from  the  studies  that  the  high-grade  feeble- 
minded fall  naturally  into  certain  groups ;  and  from  these 
groups  I  aiu  convinced  that  one  may  pass  by  imperceptible 
gradations  into  corresponding"  classes  of  non-feeble-minded 
persons,  normal  and  abnormal.  The  largest  number,  more 
than  one-third  of  my  special-study  cases,  are  characteristic- 
ally dull.  Many  of  these  are  practically  normal  in  all  the 
affairs  of  a  very  simple  life,  and  may  be  mistaken  for  nor- 
mal children  if  one  does  not  know  their  years  and  does  not 
press  them  with  inconvenient  tests  of  the  functionings  for 
which  they  have  not  grown  brains.  They  lack  mental  re- 
sources and  initiative,  and  tend  everywhere  to  automatism. 
They  rarely  learn  to  do  long  division,  and  it  is  rare  indeed 
that  one  advances  further  than  this.  There  are  doubtless  all 
shades  of  intermediary  conditions  from  these  cases  to  the 
"dull"  but  normal  pupils  who  made  up  ten  per  cent,  of 
Philadelphia's  school  classes  according  to  Dr.  Cornell's  re- 


TABULATION    OK    DATA.  169 

port,*  thoii!L;h  some  of  this  latter  dullness  was  from  remov- 
able causes.  I  sup])ose  that  ni\-  (hiil  cases  corres])oiul 
roui^hlv  to  r.inet's  arrirrcs  or  l>acL-:^'itr(i  children  as  dislin- 
iL;uished  from  his  iiiisfablcs.  In  a  general  \va}'  most  of  the 
children  max  he  classed  under  one  or  other  of  these  two 
main  i4rou])!n^s,  l')inct  fnidin^-  that  the  iM'ench  schools  have 
about  two  |)er  cent  of  each  in  a  total  of  about  five  ])er  cent 
who  are  mentally  defective.  1  f\U(\  it  convenient,  however, 
to  appl\'  the  term  iiiislablc  especiall}'  to  a  i^roup.  which  has 
at  least  four  representatives  in  the  cases  studied,  whose  main 
characteristic  is  their  instability  as  shown  in  breaches  of  dis- 
cipline, fliohty  attentir)n,  roving;'  tendencies  and  the  like, 
but  uncolored  l)y  any  s[^ccitic  forms  of  instabililx-  that  are  a> 
v.^ell-marked  as  epilepsy,  hysteria,  etc. 

There  is  an  intermediate  s^roup  of  fom-  whom  I  have  be- 
come accustomed  to  call  (/;///  mistablcs.  children  whosf  main 
or  usual  characteristic  is  their  dullness,  but  who  intermit- 
tently show  more  or  less  of  instability. 

A  fourth  gToup  is  of  the  iiciirastlu'jucally  iiiisfahlc.  My 
special  cases  include  but  two  of  these,  but  the  institution  has 
many  more.  Chronic  neurastlienia  is  generally  founded 
upon  certain  retardations  in  growth,  and  in  these  complain- 
ing but  comparatively  intelligent  feeble-minded  persons  we 
seem  to  have  the  tail-end  of  the  neurasthenia  procession. 

A  fifth  grou]),  including  but  one  or  two  of  my  special 
cases  but  with  some  little  re]:)resentation  in  the  institution, 
is  of  the  hystcricaHy  iinsfahlc.  There  is  little  doubt  but  that 
chronic  hysteria,  with  its  infantilism  and  its  frequent  develop- 
mental defects,  makes  direct  connection  with  this  group  of 
the  feeble-minded. 

A  sixth  group  includes  the  ei)ileptic  who  are  feeble- 
minded. My  original  list  of  highest-grade  cases  included 
three  epileptics.     Two  hundred  and  seven  of  the  institution 

♦See  Dr.  Cornell's  article  iu  The  PKi/clioIof/irnl  Clinic,  May  ].">.  IWS. 


170  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

children  are  considered  to  have  epilepsy  at  present,  and  there 
seems  to  be  no  donbt  that  the  feeble-minded  who  have  epilep- 
tic convulsions  are  related  by  all  degrees  of  transition  to  the 
epileptics  who  are  of  approximately  normal  intelligence. 

The  seventh  gronp  is  of  the  feeble-minded  who  show 
characteristic  tendencies  to  iiisaiiitx.  Only  one  of  my  spe- 
cial cases  shows  specific  symptoms  of  insanity ;  but  I  have 
become  accustomed  to  group  with  such  children  certain 
others  wdio  show  marked  incoherence  of  response  and  action 
with  little  appreciation  of  the  seriousness  of  their  errors.  It 
is  well  known  that  the  feeble-minded  have  a  special  pre- 
disposition to  insanity.  Tredgold  finds  this  pre-disposition 
to  be  twenty-six  times  that  of  the  general  population.  Many 
of  the  feeble-minded  are  actually  insane  for  a  part  of  the 
time,  and  the  insane  group  evidently  makes  continuous  transi- 
tions along  several  lines  to  the  dementia  praecox,  manic- 
depressive,  and  still  other  classes  of  the  non-feeble-minded 
insane. 

An  eighth  group  is  of  the  moraily  unstable.  My  special 
cases  have  contained  a  small  and  variable  number  of  these. 
One  case  had  as  his  most  striking  characteristic  an  ungov- 
ernable and  unreasonable  tendency  to  steal.  But  many  mem- 
bers of  the  other  groups  have  this  tendency  as  well,  and  on 
the  other  hand  the  "morally  unstable"  cases  show  more  or 
less  of  mental  weakness.  Still,  remembering  that  our  group- 
ings are  for  purposes  of  convenience  and  are  only  marked 
by  the  prominence  of  certain  traits,  the  term  morally  unstable 
applies  to  many  cases  not  otherwise  well  characterized,  but 
which  show  distinctive  defect  in  what  men  call  the  moral 
nature. 

A  ninth  group  is  of  the  children  whose  brains  have  suf- 
fered from  nieiiingitis  or  from  other  sources  of  injury,  toxic 
or  otherwise,  such  as  has  sufficed  to  produce  a  general  de- 
terioration.    In  still  another  group  there  is  heal  or  partial 


TAl'.ULATION    01''    J)AI.\. 


defect  of  certain  mental  nr  ])liysical  finicti(jns,  sonietinie>  ni 
the  senses,  withont  nnicli  or  any  i^eneral  nien.tal  enfecble- 
nient.  Snch  are  our  cases  of  a])liasia,  and  such  was  a  coni- 
parativelv  intelligent  deaf  unite  wln)  was  included  in  my 
orii^inal  li^t. 

Last  of  the  iir()U])in_i;s  needed  fur  our  own  special  cases, 
there  are  what  Dr.  Cornell  has  called  the  relatively  defccthc. 
children  whose  minds  would  be  comparatively  good  hut  that 
they  fail  of  their  l)est  develoi)ment  from  poor  health,  ])oor 
eyes,  or  impro])er  home  surroundings.  Prudence  S.  and 
Viola  II.  would  generally  he  said  to  belong  to  this  class, 
though  its  best  representatives  generally  manage  to  kee]) 
out  of  such  institutions. 

Of  course  the  new  adiuissions  include,  besides,  small 
groups  of  Mongolians,  cretins,  microce])halics,  h\(lrocepha- 
lics,  and  perhaps  still  others  who  show  certain  distinctive 
mental  traits.  And  even  for  the  border  cases  the  groups 
above  are  not  to  be  taken  as  either  exhaustive  or  final. 
Sometimes  the  same  chikl  may  belong  to  more  than  one 
group  or  ma\'  come  to  show  the  characteristics  of  a  different 
group  as  he  grows  older.  Indeed  many  of  these  children 
now  studied  in  their  early  adolescence  may  be  expected  to 
show  some  very  different  traits  within  a  ver}-  few  years. 
If  we  are  ])rivileged  to  follow  otit  the  life-courses  of  these 
cases,  as  T  hope  we  may  for  some  at  least,  they  \vith  others 
to  be  studied  will  help  to  suggest  the  natural  groupings  that 
we  may  finally  make  of  defectives.  The  very  dift'efent  char- 
acters and  life-conditions  foimd  for  the  various  groups  and 
individuals  here  presented  may  help  to  show  the  futility  of 
many  of  the  generalizations  about  defectives,  and  may  sug- 
gest the  importance,  for  prognosis  and  treatment,  of  obtain- 
ing a  better  knowledge  of  these  groups,  and  of  recognizing, 
as  well,  the  individuality  that  exists  even  among  the  feeble- 
minded. 


1/2  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

Certain  lines  of  transition  from  feeljle-mindedness  to  non- 
feeble-mindedness  are  evidently  suggested  in  these  studies 
and  groupings.  Connections  are  made  with  certain  obvious 
and  important  groups  of  our  "normal"  population,  on  the 
one  hand,  and  of  our  abnormal  but  non-feeble-minded  popu- 
lation on  the  other.  The  dull,  the  unstable,  the  relatively 
defective,  the  partial  defective,  are  all  about  us  performing- 
functions  in  society,  with  such  of  the  other  classes  as  can 
manage  to  make  enough  of  sane  adaptation.  The  problem 
is  the  same  for  all.  It  is  one  of  determining  the  mental  level 
of  the  life's  capacity,  actual  and  potential,  and  of  adapting 
his  environment  and  activities  to  that  level.  For  this  work 
of  adaptation,  joint  study  for  the  sociologist,  psychologist, 
and  educator,  the  careful  and  continued  study  of  cases,  nor- 
mal and  abnormal,  will  furnish  the  natural  bases  and  mate- 
rial. 


chat''I"1':r  VI. 
ASVLI.AIirS  I'OK  Till'.  CLIXUAL  I'.XAM  I  X  ATIOX 

ui'"  ciiiiJ)ki':x. 

Ideally,  the  examiner  of  a  detective  or  exce]:»tional  child 
should  interview  the  ];)arenls  and  teacher,  should  have  a  note 
from  the  famil\-  physician,  and  should  have  hefore  him  the 
record  of  a  recent  medical  and  general  physical  examina- 
tion. A  carefull)-  prepared  history  of  the  case  which  can  be 
placed  in  his  hands  when  the  child  is  presented  will  save 
much  time  even  when  parent  and  teacher  are  present,  and  is 
in  any  case  very  important  for  diag^nosis  and  prog-nosis.  If 
teachers,  social  workers,  and  others  who  send  or  bring  cases 
to  examiners  are  made  to  know  the  classes  of  facts  which  it 
it  most  im])ortant  to  obtain  in  writing  up  a  case,  they  may 
often  effect  a  great  economy  of  the  examiner's  time.  They 
should,  as  well,  learn  to  systematize  their  own  observation 
of  and  thought  about  the  cases  :  and  in  countless  instances 
all  the  examination  that  can  be  made  must  be  prepared  for 
and  given  by  themselves. 

For  economy  of  time  and  convenience  of  later  reference 
four  blanks  should  be  used  ;  one  for  the  home  record,  one  for 
the  teacher's  report,  one  for  the  ])hysical  ( including  the 
medical)  examination,  and  one  for  the  mental  examination. 
These  blanks  max-  cover  all  the  points  of  the  present  syllabus 
or  onl\  the  most  important  of  these.  The  points  underlined 
are  those  which  should  al-a'ays  l)e  enquired  about  if  lime 
permits.    The  Binet  scale,  given  here  as  the  most  usable  re- 

173 


174  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

source  for  making  a  brief  but  useful  mental  estimate,  should 
ordinarily  be  printed  as  it  stands  if  used  at  all.  Of  course 
the  variant  statements  of  the  scale  authorized  by  other  psy- 
chologists may  be  found  preferable  for  certain  purposes. 

Each  blank  should  contain  considerable  space  for  noting 
supplementary  data  not  asked  for  in  the  form  proper,  but 
often  very  important.  If  blanks  are  not  used,  the  habit 
should  be  formed  of  grouping  the  facts  under  such  general 
headings  as  heredity,  development,  medical  history,  environ- 
mental and  personal  history;  capacity,  habits,  and  character; 
school  progress,  physical  "condition,  mental  condition. 
It  is  of  great  importance  that  statements  which  seem  to  be  of 
doubtful  validity  should  be  so  mentioned,  and  that  notes  be 
made  as  to  the  apparent  trustworthiness  of  the  sources  of 
data  obtained. 

The  forms  here  presented  have  been  worked  out  in  hand- 
ling the  cases  at  the  Illinois  state  institution  for  the  feeble- 
minded. The\-  will  liave  such  modification  as  is  needed  in 
adapting  them  to  case  study  in  the  public  schools  and  in 
other  institutions.  They  give  such  suggestions  as  our  expe- 
rience has  furnished  and  are  as  incomplete  and  imperfect 
as  is  the  latter. 


TABULATION    OF    DATA. 


175 


Outline   of  Case  li.vaiitiiialioii   and  Record. 

A.     HoMi-:  Ri:((tRi). 

I.       I  Irrc'dity. 

II.        I  )(.'\(.'li  ipllH'lll. 

J II.      -Mrdical    history. 

I\'.      l^iuironiiK'iital  and   ])crs()nal   liistorv. 
A'.     Capacities,  habits.,  and  character. 

Jl.     Ti':aciii-:k's  or  .\  rTi-:.\i).\.\'i''.s  Rixokd. 

I.  Ilahits  and  characteristics, 

ir.  Capacities  and  incai)acities. 

III.  Intelh,^.ience  and  perception. 

lA'.  Learninj;-,    interests,   imitation,   and   nionory. 

V.  Morals. 

\'l.  .Social  reactions. 

C.       PUVSICWL    ICXAMIXA'IIOX.  ••      • 

I.     Anthr(j])ometr\-  and  description. 
II.     Defects  and  deformities. 
III.      .Medical  examinati(jn. 

1).     Mkntal  Examination. 

I.     Intelligence  and  retardation.     The   Uinet  scale. 


176  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

A.     HOME    RECORD. 

(Infonnatiou  to  be  obtained  from  parents,  family  pbysician, 
and  others  who  know  the  family  well). 

General. 

Child's  full  name  and  present  address. 

Name  and  address  of  parent  or  guardian. 

Date  of  birth  of  ehild.  or,  if  nnkvun^'ii,  apparent  age. 

Birthplace  of  ehild.  of  father,  of  motlier. 

Occupation  of  father  and  mother. 


Heredity. 

12         3  4  5       6  7  8        9      10       11        12      13 


Father 


Mother.. 

Father's 
father.  . . 

Father's 
mother.  . 

Mother's 
father. .. 

Mother's 
mother.  . 

Brotlicr 
or  .fist cr. 


u 

a> 

m 

O) 

t> 

it 

0 

C 

ox: 

0 
S 

l^^ 

Q 

CS^ 

Qi^ 

0 

C3 

0 

a 

h 

ffi 

5~a 


ct; 


.SS 


C  o 


k<  = 


A  svrj.Ar.us  for  cijmcai.  i:x  x.mixatiox.  177 

Ji'Iiaf  other  relaliz'cs  of  fa! her  or  inotlicr  bchui:;  itiulcr  6,  8, 
('/'  T 1 ,  <;/V'/;; o"  details:'' 

W'hicli  of  the  al)()ve  had  any  of  tlic  foll()\vini>'  condition^, 
specifying-  and  i^ivint^-  details:  Drns^'  habit,  vas^rancy, 
special  peculiarities  of  mind  or  body,  hypochondria,  sex- 
])erversion.  defect  of  si^ht.  hearing-,  or  speecli  (  statini; 
whether  con_i;enital  or  accjuired).  s])asms  or  convulsions, 
chorea,  hysteria,  neurasthenia.  ])aralysis,  other  nervous 
diseases  or  conditions,  apoplexy,  heart  disease,  sudden 
death,  goiter,  other  severe  disease  or  defect,  serious  o])era- 
tions.  confinement  in  hospitals  or  institutions  (what  and 
why?),  miscarriages  (number  and  cause?),  cancer, 
suicide  ? 

Dl'AEI.OPMKXT. 

Order  of  birth.  JJ^'i^hf  at  birth.         Borit  at  full  term? 

Deficiency  or  peculiarity  at  birth.         What? 
At  zvhat  fl^T  (///(/  ho:e  :eere  l^eeiiliarities  first  manifested f 
At  what  age  did  the  child  recognize  persons?         Sit  alone? 
vStand  alone?         Walk  alone?         Use  spoon?         Get  first 

teeth? 
First    words?         First    short    senfeiiees?         Aeqnire    tidy 

heibits? 
Know  most  of  his  letters  ?         Get  second  teeth  ?         Start 

to  school? 
What   proi^ress    at   selwol?         Stopped    at    what   age   and 

grade?         Why? 
Reads  how?         Writes  how?         Counts  to?         Adds? 
Multiplies  ?         Divides  ? 
Present  weight  and  height  ? 

Medical  History. 

What  ivas  the  condition   of  the  mother's  health  or  habits 
during  gestation? 


1/8  liACKWAKD   AND   FEEBLE-MINDED  CHILDREN. 

Was  she  mentally  troubled?         How  and  why? 

Was  labor  long  and  difficult f         Instruments  used? 

Anesthetics  ? 

Did  child  show  deficient  animation  or  vitality  at  birth? 

Difficulty  in  breathing  or  nursing? 

Any  indications  of  specific  disease?         What? 

Malnntritioii  in  infancy:^         Rickets F 

Vv'hat  troubles,  if  any,  in  teething? 

Has    child    had    the    following,    stating    age    and    severity : 
Meningitis  or  "brain  fever?"         Diphtheria?         Typhoid 
fever  ? 

Scarlet   fever?         Whooping   cough?         Measles? 

Chorea  or  St.  Jltns  dance?         Tuberculosis?         Scrofula? 

Sleep   walking?         Xight   terrors?         N^er'i'ous  attacks? 
Describe. 

Paralysis?         Describe.         \\'liat    disease   or   trouble   of 
eyes  ? 

Of  ears?         Of  nose  and  throat?         Of  skin? 

Has  child  had  epilepsy?         Fainting  spells  or  spasms? 

State  frequency  of  coni'ulsiojis,  if  any,  and  date  of  last. 

What  imperfections  of  speech?         Of  gait  and  movement? 

J  J' hat  troid-ilcs.  mental  or  physical,  at  puberty? 

At  the  monthly  periods? 

Has  the  child  been  pronouncetl  insane  or  feeble-minded? 

When,  and  by  whom? 

iVamc  any  other  diseases  or  affections  that  child  has  had. 

Has  been  in  what  hospitals  or  other  institutions,  and  why  ? 

Has    undergone    what    operations?         JVhat    severe    acci- 
dents? 

When  was  the  child  last  vaccinated?         With  what  result? 

Has  the  child  recently  been  exposed  to  infection?         State 
disease. 


A    SVLI.Al'.US    FOR    CLIXUAI,    EXAMINATION.  \/<) 

Give  name  and  address  of  physician  who  attended  at  birth 

of  child. 
Name  and  address  of  present  faiiiilx  pliysieiaii. 

h'N\IR()XMi:XT    AiNI)    i 'i:KSOX.\r.    IllSTORN-. 

I  fas  the  fajiiHy  al:eays  been  self'Siipparfiii^^.''         Cleanly/ 
How  '^eas  the  eliild  treated  by  and  leliaf  'leas  the  iiithienee 

of  the  father/ 
Of  the  iiiofher/         Of  stef-farent  or  others  ehart^ed   leith 

its  eare/ 
Was  the  ehild  indiifi:;ed.  maltreated,  seelnded/ 
How  many  persons  in  the  liome?         How  man\-  rooms? 
Was   the  home  tran(|uil  oi"  (Hsturl)ed?         Moral   eondition 

of  the  home/ 
What  -leas  the  iufluenee  of  ehild's  assoeiates/ 
Of  assoeiates  of  the  opposite  se.v/ 
What  ha-c'e  been  the  ehild's   i:;reatest  interests/ 
In  wliat  ways  has  the  child  been  useful? 
Idozi.'  does  the  ehild  spend  its  leisure  time/ 
Child's    de])ortment    and    the    impression    made,    at    school? 

At  work  ? 
Ho-cV  lo)ii^  has  ehild  zeorked/         .It  :ehat  leork  and  ■ieai:_es/ 
How  does  he  care  for  money  or  valuables  ^iven  or  earned? 

Ci\PAClTIE.S,     H. Mills.      \\1)    ClIARACTI'.R. 

To  what  extent,  if  at  all,  has  the  child  used  alcoholic  drinks?' 

Tobaeeo?         Cocaine  or  other  druses? 

IVJiat  harmful  personal  habits  (foes  he  ha-ee'^ 

Does  fie   run   aieay   from    fiome/  Ever   hide   or   destroy 

things  ? 
What  is  his  attitude  to  animals?         To  playmates?         To 

parents  ? 


t8o  I'.ACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

Is  child's  memory  good?         What  evidence  of  it? 

What  does  he  learn  rapidly  other  than  school  work? 

Does  he  pay  attention  well?  Obey  well?  Feed  him- 
self ? 

Dress  and  iindrcssF  Tic  a  slioc  lace?  Have  ii'orbid 
fears F 

Oncer  ideas?  Sf'Ccify.  Is  eliiid  aftciitii'c  to  calls  of 
nature? 

Does  he  slccf^  icell?         How  many  hours? 

Underscore  7i'ords  that  describe  child:  Trustworthy,  indus- 
trious, untruthful,  lazy,  seclusive,  moody,  cheerful,  sly, 
selfish,  slovenly,  neat,  ill-tempered,  violent,  excitable, 
thieving,  sissy  or  cry-baby,  emotional,  affectionate,  un- 
feeling, fighter,  fits  of  temper,  obstinate,  anxious,  fearful, 
complaining,  gossipy,  laugh  or  cry  without  cause,  very 
changeable,  proud  (of  what),  resentful. 

What  cause  has  been  assigned  for  deficiency  ? 

Of  what  delinquencies  has  cJiild  been  guilty?         Give  details. 

What  other  exceptional  behavior  has  been  noted  ? 

What  punishments  have  been  inflicted? 

JVhat  is  child's  attitude  toivard  correction? 

What  efforts  Jiave  been  made  to  help  child,  zvhen,  and  by 
zvhoni? 


A    SVI.I.AIUJS    I'OR    CLIxMCAI.    i:X  A  M  1  X  Al  I(  ).\  .  iSl 

B.   teaciip:r's  or  attexdaxt's  record. 

(The  child  should  l)e  under  oljservation  for  at  least  a  inonlh 
before  this  l)lank  i>  filled ). 

Observation  data  concerning- the  habits,  capacities,  and  men- 
tality of Reported  by Date 

TTaIUTS   AND   Ch  \1^\{•TI-:RI.ST1CS. 

Is  the  child  very  nervous^'         When,  ami  liox^'  shi^eii? 

Is  he  noisy?         Mischievous?  llow? 

Does  he   run   or  stray  away/         Often?         ( iet   lost? 
When  ? 

Can  he  see  w^ell?         Hear  well?         Does  he  read  outside 
of  school  work  ?         What  ? 

Does  he  wet  day  r/o////;/ <;/  Soil  day  elotliiu;^? 

IVhat  unfortiuiiite  habits,  sexual  or  ollieneise.' 

Does  he  complain  much?         Of  what? 

Ill  what  way  is  the  e/iild  most  trouhlesoine  or  faulty.'' 

In  what  does  he  most  dit^^"er,  if  at  all,  from  normal  children? 

Describe  his  habitual  position  in  study  or  recitation. 

( Underline  below  tJie  z^'ords  tluit  eorreetly  describe  thr 
child.) 
Cheerful.  Morose.  Quarrelsome.  Active.  (  )bstinate. 
Sensitive.  Moody.  Cood-tem))ered.  Excitable.  Chans;e- 
able  in  mood  or  character.  Sly.  Resentful.  Eazv. 
Slovenly.  Neat.  Cleanly.  Proud.  Of  what?  Silent. 
Talkative.  Obedient.  Generally  destructive.  Heedless 
of  danger.  Destroys  clothing.  Destroys  furniture.  Cry 
without  cause.  Laugh  without  cause.  Mouth  usually 
open.  Emotional.  Lacking  in  feeling.  Anxious.  Im- 
pulsive. Lack  self-control.  Easily  managed.  Supersti- 
tious. Apprehensive  or  fearful.  Fears  what?  Cranky. 
Humorous.     Very  stupid.     Selfish.     Cenerous.     Gossipv. 


l82  backward  and  feeble-minded  children. 

Capacities  and  Incapacities. 

Does  he  help  care  for  other  children? 

Need  careful  and  close  supervision? 

Does     he    talk?         Much?         Distinctly?         Can    he     do 

errands  ? 
Does  he  know  some  letters?         How  many  objects  can  he 

count  ? 
Cent  he  add?         Multiply?         Divide? 
Reads  iiow,  in.  .  .  .Reader?         I'nderstands  what  he  reads? 

well.  well. 

Writes  fairly.  Spells  fairly.  Copies  dictation  how? 

badly.  badly, 

well.  well. 

Draws  fairly.  Plays  fairly,  on  what  musical  instrument? 

badly.  badly, 

well. 
Sings  fairly.  W'liat  kinds  of  songs  or  music? 

badly. 
Wliat  and  lunc  ri'cV/  can   child  do   in    manual  or  industrial 

■work? 
In    kindergarten?         In    gymnastics?         In   athletics    gen- 
erally ? 
In  entertainment  work  ?         Details. 

What  other  studies  or  work  is  he  engaged  in,  and  what  prog- 
ress in  each  ? 
In  ivhaf  docs  he  do  his  best  zi'ork?         His  poorest? 
IVJiat  is  he  " ^^ood  at"  in  any  direction? 
Are  there  times  when  he  does  much  better  or  worse  than 

usual  ? 
How  account  for  these  variations?         What  prevents  his 

doing  better? 
W^hat  noticeable  defects  has  he? 


A    SVLLAI'.US    FOR    Cl.lMCAl.    i:X  A  M  I  X  ATION.  I  83 

iNTia.l.KlKXCI-:    AXI)     ri;K(  i:!-lI()X. 

Can  he  tie  an  ordinary  knot?  I  nder^iand  and  obev  com- 

mands ? 

Tell  time?         Take  care  of  api)aratns  and  furnitnre? 

llow  complicated  machines  or  tools  can  he  nse? 

I  low  well  adapt  himself  to  chan.L;e<l  schednle  or  other  new- 
conditions  ? 

Docs  he  think  of  z^'hat  to  do  in  cnici\i:;riicirs.  or  in  /^/i/y/ 
E.vaiiil>lcs. 

Wluit  other  evidences  of  ijitc/lij^cnce  or  .s7 ;//'/(/// \'/ 

ii7'cr  innii^inc  I  hot  ho  sees  ////'// -.v/  Thnf  he  henrs  :u)iees 

or  other  sounds.' 


Mo\i:mi;xts  .\x!) 


]..\\. 


Can  he  throw  and  catch  a  hall;  Dance?  llow  well? 

J  low    does    hf    walk?  Is    he    very    awkward?  \'ery 

active  ? 

I.eft-handed?  Cse    hoth    hands    e(|nall\-    well?  Is    he 

qnick  or  slow  ? 

What  automatic  movements  or  manm-risms  has  he.  and 
when  ? 

Mow  does  he  t;o  u]i  and  down  stairs? 

Play  much,  or  at  all?  I  low?  llow  lon.i;-  at  one  tiling? 

What,  for  example?  Does  he  huild  blocks'  Collect 
things  ? 

Excel  or  lead  others  in  play?  Play  over  past  expe- 
riences ? 

"Make  believe"  much  in  play?  Play  alone  or  with  others, 
usually  ? 


184         dackward  and  feeble-mindlid  children. 

Learnin(^,,  Interests,  Imitation,  and  Memory. 

Name  flic  main   Interests  noticed  in   this  cliiUi,  nndcrlining 

the  strongest. 
Does  he  learn  new  work  easily  ?         Remember  it  well  ? 
Learn  "pieces"  easily?         Remember  them  well? 
Talk  or  seem  to  think  much  of  old-time  experiences? 
Of  recent  experiences?         Is  he  z'cry  forgetful i^ 
What  does  he  imitate?         How  much  and  how  well? 
Mechanically  or  with  understanding? 
How  much  progress  or  decline  have  you  see  in  him.  in  Iwiv 

long? 
Does  he  stick  to  tasks  well?         Willing  and  tries? 
Is  he  easily  confused?         J  Then  and  Iwz^'? 
Do  you  think  he  will  improve,  stand  still,  or  go  back? 

Morals. 

Is  he  cruel?         Profane?         Obscene?         Deceitful? 

Thieving? 
Untruthful?         Lacking  in  shame  or  modesty? 
Ever  violent  to  others?         Shoz<.r  sense  of  duty? 
Of  right  and  wrong,  or  remorse? 
What    evidences    of    interest    in    religion?         Is    he    trust- 

zvorthy? 
Of  what  immoral  acts  is  the  child  frequently  or  sometimes 

guilty? 

Other  Social  Reactions. 

Is  the  child  easily  led  or  persuaded?        By  ivhom? 
Over-dependent  on  others?         Like  to  have  and  show  au- 
thority ? 
Is  he  confiding?         Chummv?         Timid? 


A    SVLLAUUS    FOR    CLINICAL    EXAMINATION.  15.5 

Bashful?         Affectionate?         Sociablcf         Sympathetic? 
What  is  liis  attitude  toward  his  parents? 
Toward  his  l)rotliers  or  sisters?         Toward  stran.s;ers I' 
Toward  animals  or  ])ets?         Does  he  i^et  on  well  7i'ith  oflia- 

children/ 
Why  not.'         Is  he  a  sissy  or  cry-baby f 

C.     PHYSICAL    EXAMINATION. 

ANTHROPOMi-rnn-  and  Di:s(  ription. 

IW'ii^ht.         //r/,i;7//  standiiii::.         Heii^hf  sitfin^ii. 
Chest  girth  at  inspiration.         At  expiration. 
Head   circumference.  Length.  Lreadth. 

Height  above  auditory  meatus.  Hair.  Eyes.         Com- 

plexion. 
Teeth.         Scars. 

Defects  and  Deformities. 
(Underscore  those  found,  in  list  below,  and  add  any  others.) 
Head:     Microcephalic,  macrocephalic,  hydrocephalic,  asyin- 

metrical. 
l-'ace:     Proi^natlunis.    inunobile,    inferior    maxillary    small. 

large,    superior    maxillary    small,    nasal    bones 

sunken,  forehead  retreating,  narrow;  face  asytn- 

inetrical. 
Nose:     Much   detlected ;    septum    abnormal,    base    of   nose 

broad,  nostrils  open  fonvard. 
Lips:     Hare-lip,  lips  very  thick,  very  thin,  fissured  above, 

below,  very  long,  very  short. 
Teeth:     Hutchinson's,     persisting     milk     teeth,     serrated, 

pointed  or  notched,  chalky,  impacted,   irregular 

in  shape  or  arrangonent,  decayed,  rachitic. 


l86  r.ACKWAKD   AND  FEEBLE-MINDED  CHILDREN. 

Soft  Palate: 

I  lard  Palate :  Cleft,  /  'shaped,  semi-V-shaped,  saddlc- 
shapcd,  high,  narrow. 

Eyes:  Pupil  irregular  or  eccentric,  conoenital  ptosis,  epi- 
canthus,  oblique  inongoiian.  palpebral  fissure 
small,  cross-eye;  asyninielry  in  size,  in  color. 

Ears:  [Vrv  large,  very  small.  Darwinian  tubercle,  abnor- 
mal dei'elopnieut,  asysnnietrical  position  or  for- 
mation. 

'foniiue :  Very  lart^e,  very  small,  thick,  flat,  j^ointed,  fis- 
sured, enlarged  papillae. 

Thyroid:     Enlarged,  atrophied,  absent. 

n^horax :  Preasts  absent,  atrophied,  small,  large,  super- 
numerary ;  development  of  breasts  in  male ; 
pigeon  breast,  funnel  breast. 

l^pper  Einil;)s  :  \'ery  long,  very  short,  asymmetrical ;  mal- 
fornuifion  of  right,  left  hand;  fingers  united, 
su])ernumerary,  two-jointed,  very  long,  very 
short.  Little  hngers  imperfect.  L, eft-handed , 
ambidextrous. 

Lower  Limbs:  Club  foot;  toes  united,  su])ernumerary ; 
knock-knee,  bow-legs,  legs  or  feet  very  long, 
very  short,  asymmetrical. 

( ienitals :  Incomplete  descent  of  one  or  both  testicles. 
Organs  over-developed,  undeveloped,  atrophied. 
I^ermaphrodism.  true  or  false.  Phimosis.  Ste- 
nosis or  reduplication  of  vaginal  and  uterine 
canals.  Cndeveloped  uterus,  ovaries,  vagina. 
Clitoris  enlarged  or  hooded. 

Skin :  Pallid,  sallow,  leathery,  prematurely  wrinkled,  birth- 
marks. 

Hair :  Coarse ;  scanty  on  face,  eyebrows,  chest,  pubes. 
Hairy  moles  or  tufts  on  body.  Bald  spots.  Eye- 
brows meet.     Abnormal  distribution  of  hair. 


A    SVI.LAIU'S    FOR    CLIN  KM.    i:X  AM  I  X  AlK  ).\  .  1  87 

Nails:  l^liin  and  triable.  ])ii;nieiite(l,  arched  and  thickened, 
lon,!^,  short,  furrowed  lengthwise,  crosswise. 

Nutrition:     .liKciiila.     Obesity. 

\'asomotor:  I'lushiiii:;.  local  heat  or  cold,  excessive  or 
local  sweating',  factitious  urticaria. 

I'nclassified :  (  ii^antisni,  dwarfism.  Ccncral  Inilaiicc  re- 
laxed. Asvmiiielncal  posture  or  head  balance. 
Scoliosis,  lordosis,  heininine  aspect.  Mincint;' 
or  shuffling-  gait. 

A r  1:1  )IC.\L    E.X  A  M  I  N  .\'ri()N . 

T.     Neuro-muscular  .System: 
(a)      Retiexes :     Knee  jerk.     Achilles.     Pupillary.     Con- 
junctival.     Plantar,      .\nkle   clonus.      Cremasteric. 
Abdominal.      Arm.      jaw.      Palatal.      rhar\ngeal. 
Defecation.     ]\Iicturition. 
(  E.xamine  others  where  indicated. ) 
(  b  )      Electrical  responses. 

(c)  Cranial  nerves:     11.   Visual  held.     Optic  discs. 

HI,    ]\',   \'l.     Strabismus.  (  )cular   movements. 

Nystai^nius.  Ptosis.  Diplopia.  \'.  (motor,  sen- 
sory.)    \1I.   (paralysis,  tics.)     L\,  N.  NKNll. 

(d)  Vertebral  column:  {  de:'iations,  etc.) 

(e)  Sensation:  J'ision  R.  E.  Ifearim^  R.  E.  Smell. 
I'aste.  IVessure.  Tem])erature.  Pain.  Muscular. 
Stereoagnosis.  Anaesthesias,  h_\'ijenesthesias,  ])ar;es- 
thesias,  cspeciallv  asymmetrical  or  local  variations. 
Headache.     Vertigo. 

(f)  Motor:  Tonicity.  Strength.  Co-ordination  or 
ataxia. 

Tremors  (coarse,  fine,  unilateral,  intentional,  spas- 
tic, ataxic,  intermittent,  undulatory).  Paralysis. 
Contractures.     Tics. 


l88  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

Spasms    (general,    unilateral,    local,    tonic,    clonic. 

purposive), 
(g)     Other  nerve  signs, 
(h)     Speech:     Stammering,  stuttering,  lisping,  defective 

articulation,  semi-mutism,  mutism, 
(i)       \\>iting:       (j)      Mimic  and  gesture:       (k)      Gait. 

2.  Eye,  ear.  nose,  and  throat : 

3.  Skin,  mucous  membrane,  trophic  disorders, 

4.  Circulation :      Heart.      Pulse.      Temperature.      Blood 

pressure.     Veins.     Arteries.     Blood.     Vasomotor. 

5.  Respiration:     Rate.     Character.     Chest  inspection. 

6.  Alimentation :      Stomach.      Intestines    and    abdomen. 

Breath.     Tongue.     Appetite.     Digestion. 

7.  Liver,  spleen,  and  pancreas. 

8.  Other   glands    ( tonsils,   adenoid   vegetations,   cervical, 

sub-maxillary,    axillary,   inguinal,    thyroid). 

9.  ( ienito-uninary    system :      Reproductive    activities   and 

misfunctionings. 

10.  Laboratory  examination  of  sputum,  blood,  urine,  etc. 

11.  Habits:     (Sleep,  drugs,  l)everages,  tobacco,  uncleanli- 

ness). 

12.  Infections,  vermin,  vaccinatioiL 


A    SVLLAUUS    FOR    CLINICAL    EXAMINATION.  l.Sg 


D.     MEXTAL    EXA.AIIXATIOX. 

Intcllis^cncL'  and  Txctardation.     Tlie  Rinet  Scale  as  Revised 
1)\-    Dr.  (ioddard.''' 

Mental  examination  of l'>orn 

School  grade l*^xaniined  b)- Dale 

Passed tests,   of expected   at 

this  age.  According  tn  these  tests,  child's  intelligence  is  aj)- 
proximately  at  the  level  of years,  indicating  a  re- 
tardation of years.     Classitied  as 

Conditions 

Mciifalify  of  One  and  7'ii'u    Years. 

1.  Eye  follows  light. 

2.  I 'lock  jilaced  in  hand  is  grasped  and  handled. 

3.  Snspended  cylinder  is  grasped  when  seen. 

4.  Candy  is  chosen  instead  of  block. 

5.  Paper  is  removed  from  candy  before  eating,  chikl  hav- 

ing seen  the  wrapping. 

6.  Child  executes  simple  commands,  and  imitates  simple 

movements. 


*WhiIe  tlie  tests  aio  here  urnnujcd  as  in  Or.  (Joddard's  rcvisiou,  and 
Ills  own  statement  is  used  for  a  few  of  them,  I  have  usuall.v  used  my  ow)i 
form  of  statement,  made  directly  from  Blnet  and  Simon,  and  intended  to 
furnish  a  practically  intelligible  form  of  record  for  the  essentials  of  each 
(est.  The  explanatory  notes  are  adapted  from  my  earlier  syllabi  for  all 
but  the  new  tests.  For  the  latter  they  make  free  quotation  and  paraphrase 
from  both  Goddard  and  Binct.  Acknowled.inment  is  hereby  made  for  this 
abundant  use  of  these  authors'  material,  without  holding  them  responsible 
for  my  modifications  in  statement. 


19^  BACKWARD  AND  FEEBLE-MINDED  CHILDREN. 

Mciitalify  of  Three  Years. 

7.  Touches  nose,  eyes,  mouth,  and  pictures  of  these,  as 

directed. 

8.  Repeats  easy  sentences  of  six  syllables,  with  no  error. 

9.  Repeats  two  numerals. 

10.  Enumerates  familiar  objects  in  pictures. 

11.  Gives  family  name. 

Mentality  of  Four  Years. 

12.  Knows  own  sex. 

13.  Recognizes  key,  knife,  penny. 

i.|.     Repeats  three  numerals  in  order,  when  heard  once. 

15.  Tells  which  is  longer  of  lines  dittering  by  a  centimeter. 

Mentality  of  Five  Years. 

16.  Discriminates  weights  of  3   and   12  grams,  6  and    15 

grams. 

17.  Draws,  after  copy,  a  square  that  can  he  recognized  as 

such. 

18.  Repeats  'T^is  name  is  John,     lie  is  a  very  good  boy," 

and  similar  sentences. 

19.  Counts  four  pennies. 

20.  Rearranges  a  rectangular  card  that  has  l)een  cut  diag- 

onally into  two  triangles. 

Mentality  of  Six  Years. 

21.  Knows  whether  it  is  forenoon  or  afternoon. 

22.  Defines,  in  terms  of  use,  the  words  fork,  table,  chair, 

horse,  mama,  three  satisfactorily. 

23.  Performs  three  commissions  given  simultaneously. 


A    SVl.I.AI'.L'S    i'OK    CLINICAL    LXA  M  1  X  ATION  .  HJl 

24.  Shows  rif^lit  hand,  left  car. 

25.  Distin.^uislics  prcltx'   from  <H.stinclly  ui;ly  or  dclonucil 

faces,  in  ])icturcs. 

Mcntcilily  of  Seven    W'urs. 

26.  Counts  13  pennies. 

27.  Descrihes  jMctm'es  sliown  in  .Xo.  lo. 

28.  Notes  oniissiiMi  of  e_\cs,  nose,  month,  or  arms,  Irom  a-- 

many  portraits,  three  of  the  four. 
2y.     J)ra\vs  (hamond   shape,   from   copy,   so  that   it  can  l)e 
recognized. 

30.  Names  red,  L:,reeu,  l)h.ie,  yellow. 

Mentality  of  lui^ht   )'cuirs. 

31.  States  difference  between  paper  and  cloth,  butterlly  and 

fl\',  wo(xl  and  glass,  in  two  minutes,  two  satisfac- 
torily. 
^2.     Counts  from  20  to  1   in  twent)-  seconds,  with  not  more 
than  one  error. 

33.  Names  days  of  week  in  order,  in  ten  seconds. 

34.  Counts  values  of  six  stami)S,  three  ones  and  three  twos, 

in  less  than  fifteen  seconds. 

35.  Repeats  five  numerals  in  order,  when  pronounced  once. 

M entail fy   of  XIne    )'ears. 

3^).      ("lives  correct  change   from   twcnl\-  cents    (two  dimes) 

paid  for  an  article  costing  four  cents. 
^J.     Defines  in  terms  su])erior  to  statements  of  use,  in  Xo.  22. 

38.  Names  the  daw  month,  day  of  month,  year,   allowing 

error  of  three  da}s  either  way  on  day  of  month. 

39.  Names  the  months  in  order,  allowing  one  omissicju  or 

inversion,  in  fifteen  seconds. 


1Q2  liACKWAKD   AND  FEEBLE-MINDED  Cllll.DkEN. 

40.  Arranges,  in  order  of  weight,  boxes  of  same  size  and 

appearance  weighing  6,  9,  12,  15,  and  18  grams,  in 
three  minutes.     Two  out  of  three  trials. 

Mentality  of  Ten  Years. 

41.  Names  a  penny,  nickel,  dime,  quarter,  half,  dollar,  two, 

five,  and  ten  dollar  bills,  in  forty  seconds. 

42.  Copies  design  after  ten  seconds'  exposure. 

43.  Repeats  six  numerals. 

44.  Tells  what  one  should  do  in  various  emergencies,  and 

answers  questions  dit^cult  of  comprehension. 

45.  Uses  three  given  words  in  two  sentences. 

Mentality  of  Eleven  Years. 

46.  Detects   nonsense   in   three   out   of  five  statements,   in 

about  two  minutes. 

47.  Uses  three  given  words  in  one  sentence. 

48.  Gives  at  least  sixty  words  in  three  minutes. 

49.  Names    three    words    that    rhyme    with    obey,    in    one 

minute. 

50.  Rearranges   shuffled   words  of  8-word   sentences,  two 

out  of  three,  with  one  minute  for  each. 

Mentality  of  Ti<<elve  Years. 


51 
52 
53 
54 

55 


Repeats  seven  numerals  in  order,  when  heard  once. 
Defines  charity,  justice,  goodness,  two  satisfactorily. 
Repeats,  with  no  error,  sentence  of  23-26  syllables. 
Resists  suggestion  as  to  length  of  lines. 
Infers    correctly    the    fact    indicated    by   circumstances 
given,  in  each  of  two  trials. 


A    SVI-I.AP.L'S    I'OR    Cl.INICAr.    EX  A.M  I  N  Alio  X  .  K;.^ 

Mciifahty  of  I- if  I  ecu   )'cais. 

56.      Interprets  ])ictnrcs  >lii>\\n  111  .\(i>.   10  and  JJ. 

^~.      Imagines  cl<)cl\-lian(ls  intfrclian^cil    fur  hour  Ci.JO  and 

for  hour  2.5f>,  U'lliiiL^'  the  time. 
5S.      W  rites  "Laui^lit  a  s])\'"  in  s\nihol>  alter  learnini^-  eode, 

one  error  permitted. 

59.  Writes    correctly    the    o])posiie    ol     seventeen    out    of 

twenty  ^iven  words. 

MciitaHfy  of  .In   Adult   ("Over   15   Years"). 

60.  Imagines  and  (h'aws  result  of  cutting  triangle  from  side 

of  twice  folded  ])ai)er. 

61.  Imagines  and   draws   new   form    ])ro(luced    hy   joining 

trans])osed  pieces  of  diagonall}'  divided  rectangular 
card. 

62.  Distinguishes  lietween  abstract  terms  of  similar  sound 

or  meaning. 

63.  Gives  three  differences  between  the  president  of  a  re- 

public and  a  king. 
f)4.     Gives  the  central  thought  of  a  selection  read  to  him. 

No  descriptive  notes  and  directions  can  take  the  place  of 
a  careful  reading  of  llinet's  articles  in  IWiiucc  Psycholos^iqiic 
for  1908  and  in  the  Bulletin  de  la  Soeieie  hhre  pour  I'Etude 
Fsychologique  de  l Enfant,  for  April,  icjii.  The  latter 
article  gives  Binet  and  Simon's  revision  of  the  original  scale. 
Dr.  Goddard,  after  using  the  Binet  tests  upon  four  hundred 
feeble-minded  children  and  two  thousand  normal  children, 
has  made  a  further  revision.'''     W  ith   very  minor  moditica- 

*'reafliors.  social  Wdrkors.  am!  others  wiio  ai'o  tliriii.sclvi's  lo  use  the 
Binet  scale  will  find  the  pamphlet  printed  by  Dr.  Goddard  in  1911,  entitled 
The  Hinet-iiiinon  Mcafniriiifi  Scale  for  IntvUUjcnvc,  to  be  tlieir  best  .u,tiide 
in  English  for  the  actual  giving  of  the  tests.  See  the  hibliography  to  this 
volume.  See  also  my  note  concerning  the  need  of  some  personal  direction 
in  addition  to  such  reading. 


194  BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 

tions  the  latter  is  the  scale  here  printed.  Most  of  the  tests 
are  the  same  as  in  the  original  scale,  but  some  of  them  have 
been  distributed  differently.  The  tests  for  thirteen  years 
have  been  placed  higher.  ,\fter  reading  Binet's  1908  article 
the  following  supplementary  notes,  bearing  the  numbers  of 
the  tests  to  which  they  refer,  may  give  sufficient  guidance 
for  making  the  tests  which  are  not  self-explanatory.  The 
first  six  tests,  really  part  of  an  older  scale  described  by 
Binet  in  VAtincc  Psycho!os;ique  for  1905,  represent  succes- 
sively higher  levels  of  mentalit}',  as  numbered,  throughout 
the  first  and  second  years. 

No.  6.  (a)  Shake  hands,  (b)  Be  seated,  (c)  Pick  up 
the  box.  (d)  Go  to  that  chair,  (e)  Come  back,  (f)  Clap 
hands  this  way.  ( g)  Hands  in  air:  (h)  on  shoulders;  (i) 
behind  back;  (j)  one  hand  around  the  other,  (k)  Rise  on 
toes. 

Nos.  8,  18,  53.  Correct  repetition  of  one  sentence  in  three 
suffices. 

Xos.  <;,  14.  35,  43,  51.  Half-second  intervals,  uniform 
emphasis,  one  success  in  three  trials. 

Nos.  10,  2/,  5A.  lUit  one  test  is  made,  by  presenting  in 
succession  three  pictures,  asking  for  each,  "What  do  you 
see  here,"  and  noting  replies.  Binet's  pictures  are  (a)  an 
old  man  and  boy  dragging  up  the  street  a  cart  laden  with 
their  household  goods;  (b)  a  poor  old  man  sitting  by  his 
daughter,  who  is  unwell,  on  a  bench  beside  the  street  on  a 
dreary  evening;  (c)  a  man  confined  in  a  room  bare  except 
for  bed,  chair,  and  tables,  and  looking  out  of  his  tiny  window. 

Xo.  12.    "Are  you  a  little  boy  or  little  girl?" 

No.   16.     Weights  are  of  same  size  and  appearance. 

Nos.  19,  26.  Child  touches  each  penny  as  counted,  tallying 
correctly. 

No.  20.    Place  the  pieces  with  the  hypotenuses  away  from 


A    SVl-LAKUS    FOR    CLINICAL    EXAMINATION. 


195 


each  other.  Child  must  discover  for  himself  that  he  has  the 
right  form.     See  that  he  does  not  turn  over  either  ])iece. 

Nos.  22,  37.  One  test  for  the  two  numl)crs.  Answers 
which  ])ass  Xo.  t^j  are  such  as  "A  iKjrse  is  an  animal  thai 
pulls  a  wagon,"  "A  mamma  is  a  lady  who  takes  care  «)f  tlij 
house,  cares  for  the  children,"  etc., — almost  an\-  response. 
indeed,  which  is  of  higher  order  than  the  simple  "A  chair 
is  to  sit  on,"  "A  table  is  to  eat  on,"  etc.,  of  Xo.  \-  grade. 
Three  of  the  five  must  be  satisfactory. 

No.  2'i^.  "Put  this  key  on  the  table,  then  close  the  door, 
then  bring  me  that  box,"  or  a  similar  series  of  directions. 

No.  36.  Play  store,  give  child  some  change,  have  him 
sell  a  box  and  actually  hand  over  the  correct  change. 

Xo.  42.  L'se  this  design.  Expose  ten  seconds.  Have 
child  draw  his  design  on  back  of  record  sheet. 


ETB 


No.  44.    What  ought  one  to  do 

1.  When  one  has  missed  the  train? 

2.  When  one  has  been  struck  by  a  playmate  who  did  not 
do  it  purposely? 

3.  When  one  has  broken  something  that  does  not  belong 
to  one? 

4.  When  he  is  detained  so  that  he  will  Ije  late  for  school? 

5.  What  ought  one  to  do  before  taking  part  in  an  im|)or- 
tant  affair  ? 

6.  Why  does  one  excuse  a  wrong  act  committed  in  anger 
more  easily  than  a  wrong  act  committed  without  anger? 

7.  What  should  one  do  when  asked  his  opinion  of  some 
one  whom  he  knows  only  a  little  ? 


196  r.ACKWARD    AND   FEEBLE-MINDED   CHILDREN. 

8.  Why  ought  one  to  jtidge.  a  person  more  by  his  acts 
than  by  his  words  ? 

Allow  at  least  20  seconds  to  each  question.  Five  of  the 
eight  must  be  answered  correctly. 

Xos.  45.  47.  \\^ords  fairly  equivalent  to  IJinet's.  for  our 
children,  are  "Chicago,  fortune,  and  river,"  with  preliminary 
practice  on  the  easier  "Springfield,  money,  and  boy."  Must 
be  completed  in  about  one  minute. 

No.  46.  Announce  that  you  will  read  some  sentences, 
each  of  which  contains  something  foolish.  Then  read 
slowly,  in  a  convinced  tone:  (a)  A  poor  bicyclist  fell  and 
broke  his  neck,  and  died  on  the  spot.  He  w^as  taken  to  the 
hospital,  and  they  fear  very  much  that  he  cannot  get  over  it. 
( b)  I  have  three  brothers,  John,  Jim,  and  myself,  (c)  Yes- 
terday the  body  of  a  poor  young  girl  was  found,  cut  in  18 
pieces.  People  think  that  she  killed  herself.  (  d)  There  was 
a  railroad  accident  yesterday,  but  it  was  not  serious.  The 
number  of  dead  is  only  48.  ( e)  We  found  a  boy,  with  his 
hands  and  feet  tied  behind  him.  locked  in  a  room.  We  think 
he  locked  himself  iiL 

After  each  number  ask  what  is  foolish  in  it.  The  whole 
test  lasts  about  two  minutes,  and  replies  must  be  satisfac- 
tory for  three  of  the  five  numbers. 

,No.  48.  Child  is  asked  to  say  all  the  words  he  can  think 
of,  such  as  table,  beard,  shirt,  go,  etc. 

No.  49.     First  illustrate  rhyming,  by  examples. 

No.  50.     ^lake  sentences  of  these  words : 

(a)  For  —  The  —  Started  —  An  —  We  —  Country  — 
Early  —  At  —  Hour. 

(b)  To  —  Asked  —  Exercise  —  My  —  Teacher  —  Cor- 
rect —  My  —  L 

( c)  A  —  Defends  —  Dog  —  Good  —  His  —  Bravely  — 
Master. 

No.  52.     Ask  "What  is  goodness,"  etc.     Such  answers  as 


A    SVl.l.AnUS    l-OK    fl.lMCAl,    i:.\.\  .M  IN  A  TK  ).\  .  i<;7 

"Goodness  is  to  share  willi  otlier^,"  "To  return  ^ood  tor 
evil:"'  "("luiritx-  is  to  i;ive  inone}'  to  old  i)eoi)le  who  cannoi 
work,"  are  satisfactory. 

Xo.  5^;.  (a)  I  saw  in  the  street  a  pretty  little  do.^.  lie 
had  eurl\  hrown  hair,  short  le.^s.  and  a  lon,2:  tail,  (h)  My 
little  children,  you  must  work  ver\-  hard  for  a  living;,  ^'ou 
must  go  every  morning  to  yom-  school,  (c)  |ohnny  i>  otten 
whipped  for  being  naught}-.  1  went  to  the  store  ajid 
bought  a  doll  for -my  sister. 

No.  54.  Prepare  a  booklet  of  six  ])ages.  (  )n  first  i)age 
draw  two  horizontal  lines,  in  ink,  the  one  to  the  lelt  two 
inches  long,  the  one  to  the  right  two  and  a  half  inches.  ( )n 
second  page,  left  line  is  two  and  a  half  inches,  right  three 
inches.  Third  page,  left  line  is  three  and  right  one  is  three  and 
a  half  inches.  On  the  three  remaining  pages  all  lines  are  three 
and  a  half  inches  long.  The  lines  on  each  page  arc  in  same 
straight  line  and  separated  by  a  half  inch.  When  the  chihl 
has  found  the  right  line  longer  three  times  in  succession, 
will  he  continue  to  make  this  judgment  even  when  he  comes 
to  those  that  are  alike,  or  will  he  resist  suggestion  and  ])ro- 
nounce  them  alike?  For  the  first  two  pages  ask  "Which  is 
the  longer  line?"     For  the  others  say  merely  "And  there?" 

No.  55.  (a)  "A  man  who  was  walking  in  the  woods  near 
Chicago  suddenly  stopped,  very  much  frightened,  and  then 
ran  to  the  nearest  police  station  to  tell  them  that  he  had  ju>t 

seen,  fastened  to  the  limb  of  a  tree,  a ?"     M) ) 

"My  neighbor  has  just  received  some  ])eculiar  visits.  There 
came,  one  after  the  other,  a  doctor,  a  lawyer,  and  a  minister 
(or  priest).     What  is  going  on  at  my  neighbor's?" 

Such  answers  as  (a)  "A  dead  ])erson  hanging,"  and  (b) 
"My  neighbor  is  dying,"  are  correct,  and  both  numbers  must 
be  answered  satisfactorily.  Doubtless  this  test  can  be  im- 
proved. 

No.  56.     In  10  and  2/  did  child  interpret  the  "feeling  of 


198 


BACKWARD   AND  FEEBLE-MINDED  CHILDREN. 


the  picture,"  usually  "by  some  word  of  sympathy,  fear,  sor- 
row, joy,  or  other  feeling?" 

No.  57.  Without  seeing-  a  watch  or  clock,  tell  the  time  of 
clay  indicated  by  the  hands  interchanged  at  these  hours. 

No.  58.  While  the  following  diagrams  are  being  construct- 
ed the  child  must  give  close  attention,  noting  arrangement 
of  letters  in  alphabetical  order,  vertically  in  the  first  and  sec- 
ond and  counter-clockwise  in  the  third  and  fourth.  The 
second  and  fourth  have  a  dot  in  each  section.  "Knowing  the 
scheme,  the  letters  may  be  left  out  and  a  cipher  dispatch  writ- 
ten by  using  for  each  letter  the  part  of  the  diagram  in  which 
the  letter  is  ])laced  in  the  key.  For  example,  'war'  would  be 
written      \/  J    T 

"Having  made  it  perfectly  clear,  remove  the  key  and  have 
child  write  on  back  of  record  sheet  'Caught  a  spy,'  in  this 
code."  Allow  one  error,  every  wrong  or  incomplete  symbol 
countins:  as  an  error. 


A 

D 

G 

B 

E 

H 

C 

F 

I 

J  ^ 

M^ 

P 

K 

N^ 

.Q 

L* 

0* 

*  R 

Note.     This  test,  recently  su;;j;ested  by  Dr.  Wm.  Healy  of  Chicago,  is  said 
to  liave  been  usel  hy  the  Southern  army  in  the  Civil  War. 


No.  59.  Hand  the  child  a  slip  of  paper  with  the  following 
words  printed  in  vertical  column,  with  space  to  write  the  op- 
posites  at  the  right  of  each:  (i)  Good,  (2)  outside,  (3) 
quick,  (4)  tall,  (5)  big,  (6)  loud,  (7)  white.  (8)  light,  (9) 
happy,  (lo)  false,  (11)  like.  (12)  rich,  (13)  sick.  (14)  glad, 
(15)  thin,  (16)  empty,  (17)  war,  (18)  many,  (uj)  above, 
(20)  friend. 

Besides  the  obvious  answers,  the  following  receive  whole 
or  half  credit:     (2)   In  or  indoors   (half  credit);   (3)  lazy 


A    SNI.l.AIU'S    F(;R    CLINICAL    I'.X  A  M  1  N  AIIOX. 


199 


or  slowly  (  half)  :  (4)  little  or  low  (  half)  ;  (j)  short  1  half)  ; 
(6)  soft  or  low  (full  crc(lh).  whis])cr  (half)  ;  (())  sorry  or 
sorrow  (half);  (10)  ri.^ht  or  truth  (half):  (' r  1  )  dislike, 
unlike,  or  hate  (full):  11^^)  healthy  (full):  (14)  mad 
(full):  (15)  broad  (half):  {i(>)  hlled  (full):  (iS)  none 
(full)  ;  (  19)  under  (full).  The  e(jui\'alenl  of  seventeen  cor- 
rect answers  must  be  .qiven. 

Xo.  60.  h'old  a  s([uare  ])a])er  in  four,  before  the  child,  and 
cut  from  it  a  small  equilateral  triangle  I>ased  on  the  middle 
of  the  closed  ed.ye.  .\sk  tti  draw  |)ai)er  as  it  will  look  when 
unfolded. 

No.  61.  Present  a  rectangular  card  cut  in  two  alon^'  a  !). 
Suppose  we  should  turn  over  the  lower  triangle  so  that  c 
should  lie  at  b  and  a  c  should  lie 
along  a  1^.  Remove  the  lower  piece 
and  have  child  image  and  draw  the 
new  total  shape  suggested,  begin- 
ning with  the  upper  piece. 
No.  62.     What  are  the  ditlerences  between — 

(a)  Pleasure  and  welfare? 

(b)  Evolution  and  revolution? 

(c)  Blvent  and  i)revent? 

(  d  )    Poverty  and  misery  ? 
(  e  )    Pride  and  pretension  ? 

No.  63.  "There  are  three  differences  between  the  ])resi- 
dent  of  a  republic  and  a  king.  What  are  thev?"  The  an- 
swer should  contain  the  three  ideas  that  (  i )  royalty  is  heredi- 
tary, while  the  ])resident  is  elected:  (2)  a  king  reigns  for 
life,  a  president  for  a  limited  period:  (3)  a  monarch  has  ex- 
tensive powers,  while  a  president's  i)Owers  are  usualK-  less 
extensive. 

No.  64.  Explain  that  }'ou  will  read  a  selection  to  which 
subject  is  to  give  close  attention,  and  thai  he  is  to  tell  the 


200  I'.AC  KW'ARD    ANl^    FRRP.LE-.MI  XDED   CTlir.DRICX. 

suljstance  of  it  afterward.  Read  slowly,  in  a  clear  voice  and 
with  expression,  the  following':  "One  hears  very  different 
judgments  on  the  value  of  life.  Some  say  it  is  good,  others 
say  it  is  had.  it  would  he  more  correct  to  say  that  it  is 
ordinary  or  of  middling"  worth  ;  l^ecause  on  the  one  hand  it 
l)rings  us  less  happiness  than  we  want,  while  on  the  other 
hand  the  misfortunes  it  brings  are  less  than  others  wish  us. 
It  is  this  ordinary  or  medium  (|ualit\'  of  life  that  makes 
it  endurable  ;  or,  still  more,  that  k'eei)s  it  from  being  ])osi- 
tively  unjust." 

The  subject  must  give  the  central  thought  in  his  own 
words  ;  c.  ^'.,  "Life  is  neither  good  nor  bad,  but  medium,  be- 
cause it  is  inferior  to  what  we  wish  and  not  as  bad  as  others 
wish  for  us." 

In  making  the  records  of  the  tests  we  use  a  plus  sign  for 
passed,  a  minus  for  failed,  an  exclamation  point  for  absurd 
response.  .V  for  failure  through  inattention,  T  for  failure 
through  timidity.  R  for  failure  through  resistance,  I  for 
failure  through  ignorance.  In  rare  cases  partial  credit  is 
given,  expressed  in  a  fraction.  The  testing  should  begin 
below  the  child's  apparent  level.  Indeed,  T  usually  try  all 
the  tests  that  T  am  not  certain  of  the  child's  passing,  and  the 
testing  should  continue  mitil  there  is  no  possibility  of  his 
going  further.  He  should  be  encouraged  and  praised  when- 
ever possible,  and  failures  should  never  be  dwelt  upon.  In 
making  the  count  the  child  is  credited  with  the  age  level  at 
which  he  i)asses  all  the  tests.  i)lus  one  year  for  each  five  tests 
])assed  at  higher  levels.  We  record  also  the  total  number  of 
tests  that  are  ])assed.  with  the  numl)er  that  should  be  passed 
at  the  child's  age.  We  have  found  it  convenient  to  use  half 
}ears  :  that  is,  the  child's  age  may  l)e  loj/^  and  his  mental 
level  8K'- 

Usually  it  is  far  better  to  be  alone  with  the  child,  and  in 
anv  case  the  test  must  not  be  discussed  or  in  anv  wav  in- 


A    SNl.L.MirS    FOR    CLIXICAL    I-'.X  A  M  IX  A  llON  .  20  I 

UTt'cTcd  with.  Man)'  of  the  child's  responses  should  be 
co])ied  vcrhatiiu.  and  notes  should  l)e  made  of  his  conduct 
shown  in  tlu'  \'arious  circumstances  of  the  testing". 

I'inalK  ,  1  would  ur^e  a^ain.  a--  earlier/'^  that  ■"these  llinet 
tests  must  he  u^-ci]  witli  iud.t;nient  and  trained  intelliLi"ence. 
or  the\-  will  certainK'  hrini;-  themseK-es  and  their  authors  into 
undeserve(l  disrei)ute.  Sucli  a  syllabus  as  is  lu^re  ])resented 
b\'  no  means  i)rei)ares  mothers  and  teachers  to  make  an_\' 
\alid  test  either  of  their  children  or  of  the  scale.  A  child 
will  often  be  >hown  to  have  the  knowled.y'e  needed  in  a  test 
in  which  he  failed,  and  the  test  will  then  l)e  called  inadeciuate. 
I'>ut  the  test  is  not  of  knowledge  merely,  but  of  the  ability 
lo  use  knowdediLie  in  meetint;'  a  situation  created  b_\-  the  stand- 
ardized conditions  of  the  test.  Results  can  l)e  considercl 
validf  onl\-  when  the  tests  are  made  by  an  experienced  psy- 
cholog'ist  who  has  familiarized  himself  with  Jiinet's  direc- 
tions, or  bv  other  competent  i)ersons  who  api)ly  the  tests 
under  the  direction  and  su])crvision  of  such  a  ])s_\'ch()loo^ist. 

If  the  tests  are  to  be  used  in  determining  who  are  to  be 
])laced  in  special  classes,  the  little  book  Lcs  Eiifanfs  An- 
onnaitx.  hv  llinet  and  Simon,  will  l)e  found  extremely  valu- 
able.    According  to  this  l''rench  ])lan,  a  pedagogical  exami- 

*.Toiirnal   of  Kil.    I'sycliolo-y.  Octobor.  1910. 

iTliat  is.  it  is  only  wlion  the  tests  are  madi'  under  suoli  eonditions  tliat 
llie  results  can  be  expected  to  be  reasonably  free  from  errors,  and  entitle;! 
to  publication  or  record  as  liaving  sucli  scientiiic  validity  as  can  l)e  claimed 
for  the  scale.  I'.ut  on  the  other  hand  1  ijuite  auree  with  l)v.  Goddard  that 
(his  and  similar  scales  will  have  a  vei-y  lari;e  use  and  usefulness  in  the 
hands  of  intelliseut  teachers  and  social  workers  everywhere,  in  makin;;- 
<ililii<i.riiii<itc  estimates  of  children's  mental  status,  for  immediate  local  use. 
The  directions  uiven  here,  snpp'fincntcd  by  those  in  Dr.  Goddard's  pamphlet, 
will  quite  sufhce  for  this,  provided  that  there  can  be  further  direction  on 
points  as  they  come  up.  and  occasional  supervision  of  the  testing  itself,  by 
some  one  who  has  at  least  been  adequately  trained  in  the  actual  giving 
of  the  tests,  only  the  exceptionally  intelligent  can  safely  dispense  with 
such  pcrsoinil  direction  and  correction,  in  the  beginning.  Indeed  the  excep- 
tionally intelligent  are  usually  themselves  among  the  tirst  to  feel  the  initial 
need  of  it. 


202  BACKWARD    AND    FEEBLE-MINDED    CHILDREN. 

nation  must  first  show  a  pedagogical  retardation  of  three 
years,  or  of  two  years  if  the  child  is  under  nine.  Then  the 
mental  tests  are  used,  and  only  the  backward  children  who 
show  an  equal  amount  of  mental  retardation  are  sent  to  the 
special  classes.  It  is  to  be  noted,  however,  that  beside  the 
ch.ildren  whose  main  characteristic  is  their  mental  'back- 
wardness' Binet  woidd  send  to  special  classes  the  "un- 
stables."  who  are  apt  to  show  a  mental  retardation  of  only 
one  or  two  vears. 


CHAPTER  VII. 

CONCLl'SION.    TIIJ^  MENTAL  EL  XCTIOXS  TO  HE 
TESTED  AXl)  (  )1'.SEKVEI). 

To  obtain  a(k'(|uate  account  of  an\-  mind  there  is.  of  course, 
much  to  be  done  beside  testing;'  the  intelH^ence.  Much  fur- 
ther knowledge  of  the  intelligence  itself  may  be  gained  by 
using  a  variety  of  tests  not  contained  in  the  scale  of  Binet 
and  Simon.  Many  of  these  further  tests  have  been  well  de- 
scribed in  recent  manuals  and  articles,  and  some  of  the  most 
usable  or  important  of  the  latter  are  listed  together  in  the 
brief  bibliography  at  the  close  of  this  volume.  As  the  syl- 
labus of  the  preceding  chapter  has  special  reference  to  routine 
work  with  cases,  it  has  not  seemed  best  to  complicate  matters 
by  attempting  here  a  formulation  of  research  tests.  A  tenta- 
tive scheme  of  the  latter  was  worked  out  at  Lincoln,  includ- 
ing, beside  many  standard  tests,  a  number  that  were  being 
newly  devised  and  tried.  However,  all  that  have  really  con- 
tributed nnich  to  an  understanding  of  the  cases  studied  have 
already  been  referred  to.  and  a  statement  of  others  may  be 
made  when  there  is  time  to  perfect  them. 

It  is  for  the  mental  levels  al)ove  the  twelve-year  limit  that  a 
further  formulation  of  tests  and  of  lines  of  observation  is 
most  urgently  needed.  Intelligence  itself  normally  continues 
to  make  some  gain  in  efficiency  and  some  transformation  in 
character  year  ])y  year  to  maturity,  and  even  on  thru  niiddk- 
life.  But  the  intellectual  advance  is  progressively  more  spe- 
cialized and  variant  with  the  individual,  making  more  diffi- 

203 


204  BACKWARD    AND    FEEP.LE-MI  NDED    CHILDREN. 

cult  its  measurement  by  any  standardized  schema  or  scale 
(jf  tests.  At  any  rate,  in  these  higher  levels  the  further  men- 
tal growth  and  the  retardations  that  concern  ns  most  are  not 
so  much  in  the  intelligence  as  in  the  feelings,  the  emotions, 
the  instincts,  and  in  the  control  and  direction  of  these  and  of 
the  functions  generally ;  in  the  new  consciousness  of  a  ne\\' 
self,  and  in  the  widening  of  social  consciousness  and  social 
relationships,  with  the  master  function  of  sex  always  prom- 
inent. 

At  these  levels  the  structures  necessary  for  all  mental  func- 
tionings  may  be  supposed  to  have  been  grown,  though  per- 
haps badly  grown  and  of  strength  insufficient  for  their  work. 
Arrest  at  these  levels  leaves  the  youth  in  the  zone  of  the 
psycho-neuroses,  characterized  in  part,  as  Dubois  of  Berne 
has  said,  by  "the  intervention  of  mind,  of  mental  representa- 
tions, in  all  their  symptoms."  The  functions  do  not  grow 
to  the  possibility  of  making  the  higher  adaptations,  or  make 
them  so  feebly  that  they  are  easily  shattered  in  emotional 
shock  and  in  the  varied  vicissitudes  of  mature  life.  "The  neu- 
roses appear  almost  always  at  the  ages  in  which  the  organic 
and  mental  transformation  is  the  most  accentuated,  says 
Janet,  "at  puberty,  marriage,  the  death  of  intimate  relatives 
or  friends,  the  changes  of  career  or  of  position." 

Into  the  classification  of  the  neuroses  it  is  not  my  pro- 
vince to  enter  here,  but  merely  to  point  out  that  they  form  the 
next  higher  rungs  in  the  ladder  of  retardation,  continuously 
transitional,  in  my  judgment,  from  certain  classes  of  the 
feeble-minded.  For  clinical  pictures  of  these  higher  defec- 
tives we  have  especially  the  extensive  and  excellent  studies 
of  Janet,  on  neurasthenia,  psychasthenia.  hysteria,  and  cer- 
tain forms  and  equivalents  of  epilepsy.  For  certain  forms 
of  hysteria  at  least,  many  would  consider  Freud  to  be  still 
more  enlightening.  Then  in  Adolf  Meyer's  interpretation 
of  dementia  prascox  we  have  an  equally  important  account  of 


MK.NTAI.    FUNCTIONS     I'O    I'.K    Ti:S'li:i)    .\NI)   (  )1!S1:K\  ED.      20^ 

other  forms  of  late  nu'iital  arrest  and  (K'tcrioratiiiii.  A^ain, 
on  lines  leading'  toward  iuanic-de])ressi\'e  and  other  forms 
of  insanity,  Krtepelin's  stU(Hes  are  well  kn(nvn  and  are  of 
eourse  illnminatini;'.  In  these  and  other  elinieal  studies  tliere 
hes^in  to  be  su^'i^ested  the  tniuiions  which  figure  m(i>t  in  the 
higher  forms  of  arrest;  the  fmietions  which  are  basal  and 
primary,  whose  imperfect  development  and  insufficient  or 
perverted  exercise  entail  serious  consequences.  Tiie  selection 
of  these  functions  and  of  tests  for  their  condition  of  effi- 
ciency or  inefficiency  is  work  for  a  clinical  psychology  that 
still  awaits  formulatidu.  As  to  what  these  functions  are  I 
shall  here  only  refer  to  some  very  tentative  notes  which  I 
have  already  printed  elsewhere  and  for  whose  revision  there 
is  now  but  little  time.  Idiey  at  least  contain  suggestions  that 
have  a  certain  value  if  happily  the  brevity  of  statement  may 
not  lead  to  t(io  much  of  misconstruction:  I'lrst  of  all. 
the  function  of  coiu[^lctcd  action  in  rapport  with  the  widen- 
ing demands  of  maturing  life,  really  the  intelligence  or  rather 
mental  efficiencv  taken  in  the  very  broadest  sense,  is  the 
most  difficult  and  highest  function,  as  Janet  so  often  m"ges. 
Then  of  less  general  functions  we  know  that  iinr-rcnicnt  and 
the  control  of  movement  are  essential,  and  we  are  indeed  al- 
ready provided  with  some  good  tests  of  this  function,  though 
standard  norms  are  yet  to  be  established.  We  know  that 
attention  is  somehow  fundamental,  that  normal  grip  that  a 
mind  takes  upon  itself  in  holding  down  to  an  adaptation 
called  for ;  and  we  know  that  attention  is  of  the  essence  of 
zcill.  The  function  of  synthesis,  of  mentally  spannin:^  nu- 
merous or  complex  elements,  is  in  part  identical  with  the 
power  of  attention,  but  onl}'  in  i^art.  Can  the  ])atient  keep 
track  of  the  score  at  a  ball  game,  make  plays  that  he  knows 
how  to  make  in  a  game  of  cards,  hold  a  row^  of  numbers  or 
objects  in  order  till  he  can  give  an  account  of  them?  It  is 
not  merely  to  have  attention  power  to  ignore  extra  or  dis- 


206  BACKWARD    AND    FEEBLE-MINDED    CHILDREN. 

tracting  factors,  but  synthesizing  power  to  face  and  use 
tiiem  all  in  getting  a  result.  Emotivity,  in  Janet's  fruitful 
use  of  the  term  for  the  general  tendency  to  interrupt  adapta- 
tions by  mal-adapted  phenomena  of  confusion,  emotion,  and 
derivation,  is  the  opposite  of  the  power  of  synthesis.  It  is 
one  of  the  most  fundamental  conditions  in  neurasthenia  and 
hysteria. 

The  function  of  fcclmg,  with  its  phases  of  susceptibility  to 
pleasure  and  pain  through  the  various  interests,  notably  the 
play  and  art  interests,  this  we  are  finding  to  be  quite  different 
from  emotion  and  emotivity.  New  means  of  testing  this 
side  of  life  are  recently  being  developed  and  it  is  not  so  im- 
possible a  field  as  it  once  seemed.  The  condition  of  the 
instinctive  activities  is  of  course  to  be  noted  as  well.  Lcorn- 
in<^,  memory,  and  the  ability  to  make  report,  together  form  a 
practical  function  of  the  greatest  importance.  Reasoning, 
just  the  intelligence  made  articulate  by  the  use  of  general 
rules  and  abstract  conceptions,  is  to  be  examined  as  a  devel- 
opment of  the  intelligence. 

Then  we  have  the  function  of  forming  ideals  and  of  esti- 
mating values  and  relative  worths,  for  the  guidance  of  judg- 
ment and  action.  There  are  the  self-estimations  and  self-re- 
lationships which  make  up  the  social  phases  of  mind  and 
which  include  the  bases  of  morals  and  religion.  And  there 
is  the  function  of  self-direction  and  the  opposite  tendency  to 
a  mental  attitude  and  condition  of  dependence.  There  is 
further  the  difficult  but  not  so  hopeless  problem  of  tempera- 
ment and  personal  attitude. 

In  certain  cases,  certainly,  the  characteristics  of  association 
and  of  the  train  of  thought  become  of  extreme  importance, 
and  the  orientation  in  space  and  time.  The  rate  and  degree 
of  intensity  at  which  mental  work  goes  on,  the  behavior  in 
the  face  of  difUculty.  the  facility  of  fatigue  and  of  recupera- 
tion, are  also  to  be  estimated.    Most  fundamental  of  all,  for 


ME.XTAL    FUNCTIONS    TO   BE   TESTED    AM)   ()1!S1;R\  I'.l).      20/ 

interpreting'  a  great  variety  of  eases,  is  the  ability  to  main- 
tain a  sufficient  and  normal  Ici'cl  of  mental  fimetioning  or  or 
])svehie  tension.  Janet,  for  instance,  believes  that  the  essen- 
tial fact  of  the  functional  neuroses  is  the  inability  to  reach 
or  to  safelv  maintain  Udrmal  levels  of  functiniiing. 

Whatever  the  fundamental  fvmctions  may  l)e  it  is  a  next 
step  to  determine  at  least  more  of  them  than  have  usuall)' 
been  clearly  in  mind  when  tests  were  ])lanned.  Not  that  for- 
mal tests  can  or  need  be  applied  to  all  functions,  though  ihcy 
can  help  in  the  study  of  most.  Nor  that  a  mind  can  be 
picked  apart  and  the  ]Heces  measured  piecemeal.  In  testing" 
anv  function  the  mind  is.  of  course,  exercised  in  many  other 
ftuictionings.  Ihit  a  pro])er  test  calls  the  selected  function 
into  dominant  action,  the  conditions  are  standardized  with 
reference  to  it.  and  the  observation  and  record  are  devoted 
to  it.  In  making  tield  observations  and  especially  in  working 
up  field  data  the  emphasis  will  come  to  be  placed  on  what  is 
found  to  happen  when  these  fundamental  functions  are  in- 
volved. Perhaps  at  present  we  need  most  of  all  a  better  for- 
mulation of  methods  of  field  study ;  and  possibly  if  much 
more  attention  were  paid  to  the  life-course  of  the  i:)atient 
rather  than  to  the  multiplication  of  tests  there  would  be 
quicker  progress  to  a  decision  as  to  which  tests  are  worth 
while. 

Professor  Binet  has  rendered  a  great  service  by  determin- 
ing the  normal  behavior,  at  each  age  to  twelve,  of  a  group 
of  related  functions,  mainly  of  the  intellect  and  loosely 
classed  together  as  the  "intelligence";  a  term,  by  the  way. 
that  has  come  to  have  a  very  elastic  content.  The  phases 
of  mind  that  are  measured  in  his  scale  are  fairly  typical  of 
mental  growth  to  the  dawn  of  adolescence.  Which  of  our 
investigators,  competent  to  the  task,  will  make  sure  of  some 
great  function  or  group  of  functions  that  rises  into  domi- 
nance in  this  adolescence  period,  and  will  work  out  for  each 


208  liACKWARD    AND    FJiiir.Lli-MI  NDIilJ    C  llll.DKICX. 

advance  in  years  its  normal  Ijchavior  and  transformation? 
When  there  has  been  such  wise  selection  of  the  trunk  lines 
along  which  mental  development  goes  forward  in  these  later 
years,  and  of  the  ty])ical  modes  of  deviation  and  arrest,  and 
when  we  know  the  normal  j^rogress  to  be  exi^ected  along  each 
line  with  each  added  year,  we  shall  then  have  constituted  a 
balanced  scale  of  norms  for  the  later  development  of  the  es- 
sential mentality.  Such  a  scale  will  by  no  means  be  limited 
to  a  formulation  of  tests,  though  it  will  include  such  tests  as 
can  be  utilized.  But  it  will  give  normal  standards  for  judg- 
ing the  life  as  observed  in  its  natural  and  normal  activities. 
All  this  is  work  for  none  but  the  most  mature  and  com- 
petent men  who  have  abundant  freedom  and  facility.  For  the 
workers  in  the  field  I  believe  that  a  faithful  following  of  the 
fortunes  of  individual  cases,  using  any  tests  and  methods  of 
observation  and  study  which  will  help  to  throw  light  on 
essential  conditions,  is  the  kind  of  work  most  needed  at 
present.  For  statistical  study,  reliance  cannot  be  placed  on 
the  present  means  for  gathering  data  in  most  institutions  : 
and  it  seems  to  me  that  in  the  present  "frontier"  stage  of 
this  work  the  man  who  keeps  face  to  face  with  his  cases  and 
who  works  up  the  case-background  in  the  light  of  which  his 
observations  are  to  be  interpreted,  is  the  man  wdio  is  likely 
to  help  most  to  a  real  understanding  of  defectives. 

In  this  belief,  perhaps  the  very  iiuperfections  of  these  case- 
studies  and  of  these  tentative  syllabi  and  concluding  for- 
mulations may  encourage  others  to  frankly  begin  in  then- 
own  best  way,  with  the  cases  and  resources  that  are  now 
accessible  to  them.  They  will  find  the  work  of  the  clinician 
to  be  as  full  of  fascination  as  it  is  of  opportunity  for  far- 
reaching  service. 


Pill'.LIOGRAIMIV. 

The  following'  list  of  ])ooks  and  journals  includes  llic  most 
indispensable,  with  some  others  that  will  assist  in  ])re])arin}4' 
for  actual  work  with  cases.  Hiblio!^ra|)hies  in  the  works 
here  cited.  es])eciall}-  those  by  (ioddard  and  MacDonaM,  will 
,^'ive  abundant  further  references.  Dr.  ( loddard  has  in  i)rep- 
aration  a  much  more  extensive  biblio.^raphy.  A!an\-  very 
valual)le  short  articles  not  listed  here  are  included  in  earlier 
volumes  of  the  journals  listed.  Sets  of  these  journals  should 
be  at  hand  at  least  to  the  extent  su.s^ijested  below.  Any  jour- 
nal or  book  listed,  and  especiall}'  the  foreitin  journals.  ma\- 
be  conveniently  obtained  throu,Qh  (i.  E.  Stechert  (S:  Co..  New 
York,  or  A.  C.  McClurg  &  Co.,  Chicago. 

JOURN.A.LS. 

Psychological  Clinic.  The  Psych.  Clinic  Press,  Philadel- 
phia.    Complete  set  should  be  owned,  and  is  inexpensive. 

The  Training  School.  Published  by  X.  J.  Training  School, 
X'ineland,  N.  J.  Last  four  or  five  volumes  should  be  owned, 
and  are  quite  inexpensive. 

.Journal  of  Psycho- A  sthenics.  Published  by  Minn,  .^chool 
for  the  h'eeble-minded.  b^aribault.  .Minn.  \ Ols.  XI\'  and  X\' 
should  be  obtained. 

The  Snr-i'cy.     Xew  York. 

American  Breeders'  MagazdriC.    Washington.   1).  C. 

Pngcnics  Rcvici^'.  Published  by  the  Rugenics  iMliicational 
.Society,  London. 


210  BACKWARD    AND    FEEBLE-MINDED    CHILDREN. 

Folfa  Rciicic.    X^^lta  Bureau,  Washiugton,  D.  C. 

Jounuil  of  liducational  Psychology.  Warwick  &  York, 
Inc.,  Ijaltiniore,  Md.    Obtain  \'ols.  l-II  to  date. 

School  Hygiene.  Dr.  Geo.  S.  Badger,  48  Hereford  St., 
Boston,  Mass. 

Pedagogical  Soiiiiuiry.  Clark  L^niversity,  Worcester, 
Mass. 

Journal  of  the  American  Institute  of  Criminal  Law  and 
Criminology.     Chicago,  Bl. 

Eos.     Published  by  A.  Pichler's  Witwe  und  Sohn.  Wien. 

Die  Hilfschule.     Carl  ^larhold,  Halle,  a.  S. 

I'Annce  Psychologique.  Masson  et  Cie,  Paris.  Obtain 
the  volumes  at  least  as  far  back  as  1908  or  1905. 

Zeitschrift  filr  die  Erforschnng  and  Behandlung  des 
Jngendlichen  Sclncaclisinns.     Gustav  Fischer,  Jena. 

Zeitschrift  fiir  Kinderforschung.  Beyer  und  Sohne,  Lan- 
gensalza. 

Bulletin  de  la  Societe  librc  four  I'Etudc  psychologique  de 
leufant.     Paris,  191 1.     Inexpensive,     (iet  the  back  numbers. 

TESTS  AND  SYLLABI. 

Whipple:  Manual  of  Mental  and  Physical  Tests.  War- 
wick and  York,  Bic,  Baltimore,  Md..  i<;io. 

Goddard.  The  Binet-Simon  Measuring  Scale  for  Intelli- 
gence. Revised  Ed.,  191 1.  Published  by  the  Training 
School,  Vineland,  X.  ]. 

Binet  et  Simon  :  Articles  on  measurement  of  the  intelli- 
gence, in  I'Aunee  Psychologique,  1905,  1908,  and  elsewhere, 
and  in  Bulletin  de  la  Societe  librc.  etc.,  for  April,  1911,  espe- 
cially. See  Kuhlman  in  Journal  of  Psycho-Asthenics,  Yol. 
XA',  and  Goddard  reference  above,  for  partial  translations 
of  Binet-Simon  articles  on  tests. 


MKNTAL    I'UNCTIONS    'lO    V.V.   •|'i:STl':i)    AND   (  )I'.S1:r\  i:i ).      _'l  1 

Kiic}- :  Tlu'  liiiu't  McasuriiiL;'  Scale,  j.  of  I'.il.  I'sxcliul- 
oj4y,  ( )ct.,   Hjio. 

Hue}':  A  S\llal)us  for  the  C'linieal  I'",xainiiiati()ii  of  C'liil- 
dreii.  Warwick  &  York,  llaltiniore,  Md..  i<)\\.  W  arwick 
aml  \'ork  also  supply  record  blanks  for  liinet  tests,  in  (juan- 
tities  of  a  dozen  or  more. 

Healy  and  Fernald  :  Tests  for  Practical  Mental  Classifi- 
cation. The  Psychological  Review  Co..  I'altiniore.  Md., 
191 1. 

White.  W'm.  A.  :  Outlines  of  Psychiatry.  .\ew  \>>vk.  i()i  i. 
Contains  much  on  methods  of  examination  and  tests. 

Galton,  1'". :  Report  of  the  Anthro])ometric  Committee  of 
P)ritish  Association.  London,   1893. 

Macdonald,  Arthur:  See  especially  his  juvenile  ("rime 
and  Reformation,  under  "Hooks  and  Articles." 

Norsworthy  :  Psychologx'  of  Mentally  Deficient  Lhildren. 
N.  Y.,  1906. 

Chicago  Child  Study  Reports,  of  wSmedley,  ^Macmillan, 
Bruner.     Published  by  P>oard  of  Education,  Chicago,  Til. 

Kent  and  Rosanofif:  A  Study  of  Association  in  Insanity. 
American  Journal  (^f  Insanity.  \  ol.  LW'll,  Nos.  r  and  2, 
1910. 

Jung:  Diagnostische  Assoziations — Sludien.  \  ols.  1  and 
II.  Leipzig,  1906  and  1910. 

Toulouse:     Emile  Zola.     Paris.  1896. 

Report  of  Committee  on  Tests,  American  Psychological 
Association,  1910.    Psych.  Review  Pub.  Co.,  Baltimore.  Md. 

One  should  also  own  or  have  access  to  some  standard 
manuals  of  laboratory  experimentation,  such  as  Titchener's 
Experhncntal  PsycIwloi:;y.  Toulouse  et  Pieron's  'rcchnique 
de  Psychologic  Expcyimoifalc,  etc. 


212  BACKWARD    AND    FEEBLE-MINDED    CHILDREN. 

BOOKS   AND  ARTICLES. 

Tredgokl :  Alental  Deficiency.  N.  Y.,  1908.  One  of  the 
very  best  general  treatises. 

Barr,  iNIartin,  W. :  Mental  Defectives.  Philadelphia, 
1904. 

Shuttleworth  :  ^Mentally  Deficient  Children.  London.  Get 
recently  revised  edition. 

Ireland,  W.  W. :  The  Mental  Afl:ections  of  Children. 
London,  1898. 

Seguin :  Idiocy,  and  Its  Treatment  by  the  Psychological 
Method.     Brandon  Printing  Co.,  Albany,  N.  Y.,  1907. 

Dannemann  :  Enzyklopadisches  Handbuch  der  Heilpada- 
gogik.    Carl  Marhold,  Halle,  a.  S. 

Goddard :  Bibliography  of  Mental  Deficiency.  N.  J. 
Training  School,  Vineland,  N.  J. 

Goddard :  Heredity  of  Feeble-Mindedness.  American 
Breeders'  Magazine,  Vol.  I,  No.  3,  Washington,  D.  C. 

Goddard  :  Two  Thousand  Normal  Children  Measured  by 
the  Binet  Measuring  Scale  of  Intelligence.  Pedagogical 
Seminary,  June,  1911. 

Huey :  Retardation  and  the  Alental  Examination  of  Re- 
tarded Children.    Journal  of  Psycho-Asthenics,  Vol.  XV. 

Meyer.  Adolf:  Preventive  Mental  Hygiene.  Psycholog- 
ical Clinic,  June  15,  1908. 

Meyer,  Adolf:  Dementia  Pr?ecox.  R.  G.  Badger,  Boston, 
1911. 

Henderson,  Chas.  R. :  Introduction  to  the  Study  of  the 
Dependent,  Defective,  and  Delinquent  Classes,  and  of  their 
Social  Treatment.    2nd  ed.,  Boston,  1901. 

Binet :     Les  Enfants  Anormaux.     Paris,  1907. 

Janet,  Pierre :    Les  Nevroses.    Paris,  1909. 

Macdonald,  Arthur:  Juvenile  Crime  and  Reformation. 
Govt.  Printing  Office,  Washington,  D.  C,  1908. 


MKNTAL   FUNCTIONS    TO   P.R   TESTED   AND  OP.SER\1:d.     213 

Macdoiiald.  Arthur:  Man  and  Al)nornial  .Man.  Govt. 
Printing^  Ofifice.  1905. 

Wallin :  The  New  Chnical  Psyche jIoi^v  and  the  f'sycho- 
CHnicist.     Journal  of  Va\.  Psych..  .Marchi  and  April.  i(;ii. 

Ayres,  L.  1'.:  Lai^t^ards  in  oiu"  Schools.  Charities  Pub. 
Com.,  N.  Y.,  1909. 

Reeder,  R.  R. :  How  200  Children  Live  and  Learn.  Char- 
ities Pub.  Com.,  X.  Y. 

Parmelee :  Anthro])ol(i,i^y  and  Sociology  in  Relation  to 
Criminal  Procedure.     The  Macmillan  Co..  X.  V..  T908. 

Msennel :  The  Auxiliary  Schools  of  Cerniany.  (lovl. 
Printing  Office,  Washington,  D.  C,   1907. 

Cornell,  W.  S. :  Mentally  Defective  Children  in  tlie  Pub- 
lic Schools.     Psych.  Clinic,  Ma\'  15,  ujoS. 

]\IacMurchy,  Dr.  1  lelen :  Feeljle-minded  in  Ontario. 
Govt.  Report  for  1910.     L.  K.  Cameron.  Toronto,  kjif. 

Holt,  L.  E. :  Diseases  of  Infancy  and  Childhood.  I'lflh 
ed.,  ii;io. 


INDICES 


INDEX  OF  CASES 

licTiiiM  A ni 

I'.fiilali     X Tf. 

( 'aspiu-    II i:{4 

Cliirciici.  A ]il5 

(Krliiii    (• ST 

David    F 1-I,s 

Delia    II Il'S 

Dora  M 58 

Fanny    H 11!) 

Folix     N 31 

Frod  J 2J. 

Fritz  A 14:^ 

( JoorRc    J IL' 

Harold   K ill 

Harriet   (i li'5 

Hester  A tiT 

Hilda    E nz 

Jerry    H -K 

Kenneth     M 139 

Marshall  E M 

Milton    J 1 10 

Minnie  (J 7: 

Morton     \V 95 

Nora    D lUii 

I'olly  A Sr, 

Prudence    S M 

Robert    1' ',i 

Samuel  J 137 

Stanley   D 107 

Theresa    II 153 

Vineent    (' 145 

Viola    II liiJ 

Wendy    J 131 

Wilda    (' lit; 

Winnie    D 42 


INDEX  OF  SUBJECTS  AND  NAMES 


A— CaiU'ellatiou.  l<!3-4,  iiud  see  case 
studios. 

Age  of  new  admissions,  15-17. 

American  Association  for  .Study  of 
Feelile-minded,  (J. 

I"Annee  Ps.vcliol<)gi(iue.   193-4, 

Aphasia,  89.  91  ff.,  95  ft".,  171. 

Apraxia,  89. 

Association  tests,  26,  .39,  44,  49,  52.  60, 
64,  68,  84,  144,  163-5. 

Attendant's  record,  181-5. 

Attention  defects,  23  ff.,  56,   85. 

Automatism,  38,  44,  49,  82  If..  142,  144, 
52,  60,  79. 

Backward,  use  of  term,  7-8,  169. 

Binet,  I'rofessor,  6,  163,  169,  202,  207. 

Binet  and  Simon  tests,  9-10,  157,  173, 
189  ff. 

Blanks,  173  ff. 

Burt's  alpliabet  test,  48-9. 

Capacities,  179,  180,  182. 

Chicago  Child  Study   Reports,  160. 

Chorea,  128. 

Classification  and  terminology.  5  ff. 

Classification  of  defectives      168  ff. 

Clinician-educators,   viii. 

Colored  children,  113,  153. 

Control  defective,  27,  28,  34,  38,  W),  65, 
75  ff.,  78,  81,  88,  97,  10<l-l,  104,  ]08  ff.. 
Ill,  114,  123-4. 

Convulsions,  13.  31,  36,  54,  69,  75  ff,  78, 
87,  95,  99,  17S. 

Cornell,  Dr.,  1C8,  171. 

Criminals,  feeble-minded  are  poten- 
tial, 20. 

Dancing,  51. 

Defects  and  deformities.  185  ff. 

Dementia  praecox,  86,  204. 

Development,  data  as  to,  177. 

Difficulty,  tests  of  behavior  in  meet- 
ing, 96. 

Dull  children,  42.  46,  51,  54,  58,  119, 
122,  128,  ^l,  134,  137,  139,  142,  145, 
148,  ISS. 


Dwarf,   139,  148. 

Knidtivily,  2<i6  ;  sci'  Control. 

lOuviroiiiiiciU  ;iiid  i)ersonal  history, 
ll'.t. 

lOpilepsy,  13.  70,  75,  169  ;  see  Convul- 
sions. 

lOxaraination  of  children,  173  if  :  out 
line  of,  175. 

Feeble-minded,  numbers  of,  1 :  de- 
fined, 6-9 :  diagnosis  of,  8,  19 ;  of 
fair  intelligence,  17-18  ;  individual- 
ity of,  171 ;  transitions  from,  to 
non-feeble-minded,  157  ff. 

Dr.   Fernald.   I.   20. 

Field  study,  need  for  metliods  of. 
207. 

Freud,  I'rofcsscjr,  204. 

Functions  to  be  tested,  203  ft". 

(ie.stures,  over-use  of,  84  ff. 

(ilasses.  not  often  worn  by  institu- 
tion children.  167. 

(ioddard.  Dr.,  x,  3.  157,  189,  193,  201. 

(iossip,  tendency  to,  77. 

(iroup  work,  29. 

Habits,  179,  181. 

Habits  aid  attention,  29-30. 

Ilealy.  Dr.  Wm..  x.  198. 

Hearing.  12.  14.  158-9.  and  see  casi^ 
studies. 

Directions,  tests  for  knowledge  of, 
161,  162. 

Hardt,  Supt.  H.  G.,  ix. 

Heredity  data,  176-7. 

Higher-grade  defectives,  16-21,  151, 
168,  viii. 

History  of  case,  facts  needed,  173  ff. 

Home  record  of  children  studied,  21 : 
outline  for.  176. 

Hydrocephaly,  apparent,  148. 

Hysteria,  67,  72,  78,  169. 

Idiot,  5-9. 

Imbecile,  5-9. 

Insane,  numbers  of,  1. 

Insane  children,  81  ff. 


220 


BACKWARD    AND    FEEBLE-MINDED    CHILDREN. 


Insanity,    children    wlio    show    ten- 
dencies to,  81,  170. 
insanity,  prevention  by  clinical  over- 
sight  In   schools,   viii. 
Institutions  will  not  care  for  higher- 
grade  defectives,  viii. 
Intelligence.  S,  91  ff.,  183,  203,  207. 
Intelligent   children   in   institutions, 

22,  62,  75.  91,  95,  99.  102,  148.  1.53. 
Janet.  Professor.  204-7. 
Joking.  97.  137. 
Journal  of  Educational  Psychology, 

201. 
Jung's  Studien.  165. 
Kent  and  Rosanoff,  165. 
Keratitis.  113.  116,  125. 
Kraepelin,  Professor,  ix,  205. 
Language   disturbances,   14,   25,   33-4. 
38,  39,  47,  48,  52,  56,  58,  59,  64,  73-4. 
85,  89,  100,  114,  120,  126,  132.  135,  13N. 
141,  146,  150 ;  see  Spelling,  Writing, 
etc. 
Lathrop,  Miss  Julia  A.,  x. 
Learning,    capacity    for.    184 :    auto- 
matic   functioning    mistaken     for. 
see  under  Automatism. 
Left-hand  disproportionately  strong, 

42,  102,  158-9,  167,  et  al. 
Level,  adjustments  of,  172. 
Level,  of  psychic  tension,  207. 
Lincoln  State  School  and  Colony.  3, 

4,  10,  174. 
Local  or  partial  defect,  170. 
Lying,  66,  108,  115,  143,  145. 
Manual  work,  viii,  29,  57,  133.  151,  154. 
McCallie     audiometer     and     vision 

cards,  160. 
Medical  examination,  187  ff. 
Medical  history,  177-8. 
Medicine  and  psychologj',  ix. 
Memory  defect.  48,  77,  et  al. 
Meningitis,  13,  87,  95,  170. 
Mental  age  of  new  admissions,  15-17. 
Mental  description,  5,  203  ff. 
Mental    examination,     syllabus     of, 

189  £f. 
Meyer,  Dr.  Adolf,  ix,  204,  212. 
Mimic  defective,   32  ff.,   90,   93,   95  ff., 

109,  112. 
Mongolians,  12,  13. 
Moral  imbecile,  105. 
Morally  unstable,  105,  170. 


Morals,    observation    and   record   of, 

184. 
Moron.  7. 
Movement  and  control  of  movement, 

;\s    function    to    be    tested,   183. 
Music,  effect  of.  24,  29.  32  ff. 
New   Jersey  Training   School,   3. 
Neurasthenia,   62  ff.,   72,   169. 
Normality  of  intelligence,  9,  18-19. 
Occupation,   choice  of,  167. 
Opposites,   test  for,  163-4,  198-9.   and 

throughout  case   studies. 
Orientation    tests,    161-2 ;     also    see 

case  studies. 
I'edagogy,    experimental,    in    institu- 
tions, 3. 
Personal  interest  as  factor  in  train- 
ing.  29. 
Philadelphia,       dull       children       in 

schools  of,   168. 
Physical    examination.    185  ff. 
Play,    observations    of,    91  ff..    96  ff.. 

183. 
I'remature  birth,  54,  144. 
I'sycho-neuroses,   204. 
Relatively   defective,    171. 
Religion,  tendency  to  talk,  77,  84. 
Retarded,  use  of  term,  8. 
Research   tests,  203. 
Rosanoff,  Dr.,  165. 
Royal   Commission,  6. 
Schools,  feeble-minded  in,  1,  14 ;  ex- 
ceptional children   in,  vii. 
Senescence,   premature,  82,  139. 
Sensory  acuity,  12,  14,  158-9. 
Sex,  male  most  liable  to  mental  de- 
fect, 14. 
Sex    tendencies,    61,    66,    77,    104,    117, 

118. 
Similars,   test  for,  162,   164,   and   see 

case  studies. 
Simon,  Dr..  201.  et  al..  .ioint  author 

of  "Binef  tests. 
Smcdley     cephalometer     and     dyna- 
mometer, 160. 
Social    reactions,    184,    and    see   case 

studies. 
Sound   associations,   60,  69,   106. 
Special  classes,  vii,  7. 
Spelling  of  defectives,  33,  34,  39,  48, 
52,  56,  64,  6S,  74,  79,  83,  100,  103,  117, 
120,  123,  133,  135,  141,  146,  155. 


M)i:x  oi'  srii|i:c  rs  wd   .\.\mI':s. 


221 


Stiilc    Hoard    .if    Adiiiiiiistration,    of         rifilKohl.   1  "r..   l:t.  170. 


Illinois,    ix. 
Statistical  stiid.v.   L'OS. 
Story    invention,    ICl.    Iff.    and    see 

case  studies. 
Story    reproduction.     Iilii  1.    and     see 

case  studies. 
Synthesis,   fund  ion  of,  2ii,t. 
Teachers,  clini<"il  <'ounsel  to,   vii. 
Teacher's   record,   181-5. 
Tests,    description    and    results    of. 

157  ft'.,  and  s-ee  case  studies. 
Thieving.  50.  6(i.  W\.  ins.  112.  li:!,  1 1:!. 

145. 
Thought  processt's  of  feeble-minded. 

See  Language  disturbances.  Auto- 
matism. Association,  etc. 
Thyroid,  affection  of,  12,  67,  131,  i:!7, 

153. 


Truanc.v,  110  et  al. 


ITnstablo   children,    1!),   22,   31,   :!«, 

53.    5(,   5S!,    (;2,    ti7,    72.    75,    SI.   S7, 

105,    107,    110.   li:{.    IIH.   131,    133-4, 

ff.,    W.K 
Urticaria.   73. 
Vagrancy,  llo. 
Vision.     12.     II,     i:.s;<.     and     see    < 

studies. 
\'oi(Cs   of  defectives,   37.   3S. 
Welirlin.    K..   165. 
Whipple.  Professor,  160,  163,  210. 
Writing  of  defectives,  25,  26,   33, 

IS,    ,52.    59,    t;4,    6S,    79.    100.    114. 

120,    123.    126,    129,    132,    135,    144, 

155, 


^ 


"^ 


'■^o 


L  006  128  871   8 


/vV  000  548  753    3 


